Efficacy of Pharmacotherapy and Cognitive Therapy, alone and in Combination in Major Depressive Disorder

Shamsaei, Farshid; Rahimi, Alireza; Zarabian, Mohammad Kazem

doi:10.1016/s0924-9338(09)70909-5

Cited by 12 publications

(16 citation statements)

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“…The effect size indicating the difference between psychotherapy and combined treatment was 0.40 (95% CI: 0.13∼0.67). Heterogeneity was moderately high and significant ( P < .05), but after removal of one outlier, heterogeneity became small and non‐significant.…”

Section: Resultsmentioning

confidence: 98%

Personalized Treatment of Adult Depression: Medication, Psychotherapy, or Both? A Systematic Review

Cuijpers¹,

Reynolds

Donker³

et al. 2012

Depress Anxiety

143

110

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Background: Personalized medicine aims to identify which characteristics of an individual predict the outcome of a specific treatment, in order to get a better match between the individual and the treatment received. We conducted a systematic review and meta-analysis of randomized trials comparing two treatments directly in a group of patients with a specific characteristic. Methods: We searched relevant studies from bibliographical databases and included trials comparing (1) medication with psychotherapy, (2) medication with combined treatment, and (3) psychotherapy with combined treatment, in specific target groups (a) with a predefined sociodemographic characteristic, (b) a specific type of depression, (c) a comorbid mental or somatic disorder, or (d) from a specific setting (outpatients, primary care). Results: We included 52 studies with 4,734 depressed patients. In these studies, 20 characteristics of the target groups were examined. The results showed that medication is probably the best treatment for dysthymia, and combined treatments are more effective in depressed outpatients, as well as in depressed older adults. However, in order to examine the 20 characteristics in the three categories of comparisons, 254 studies would be needed for having sufficient statistical power to show an effect size of g = 0.5. Currently, only 20.1% of these studies have been conducted. Conclusions: Although a considerable number of studies have compared medication, psychotherapy, and combined treatments, and some preliminary results are useful for deciding which treatment is best for which patient, the development of personalized treatment of depression has only just begun. Depression and Anxiety 00:1-10, 2012.C 2012 Wiley Periodicals, Inc.

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Section: Resultsmentioning

confidence: 98%

Personalized Treatment of Adult Depression: Medication, Psychotherapy, or Both? A Systematic Review

Cuijpers¹,

Reynolds

Donker³

et al. 2012

Depress Anxiety

143

110

View full text Add to dashboard Cite

show abstract

“…For depression studies, 21 studies were included [7,[48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67] with 1,095 patients randomized to medication and 932 patients randomized to therapy. Forest plots of posttreatment CBT minus medication effect sizes are shown in Figures 2 and 3 for anxiety and depression, respectively.…”

Section: Resultsmentioning

confidence: 99%

Relative effects of CBT and pharmacotherapy in depression versus anxiety: is medication somewhat better for depression, and CBT somewhat better for anxiety?

et al. 2011

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Background: Little is known about whether cognitive behavioral therapy (CBT) or pharmacotherapy is relatively more advantageous for depressive versus anxiety disorders. Methods: We conducted a meta-analysis wherein we searched electronic databases and references to select randomized controlled studies comparing CBT and pharmacotherapy, with or without placebo, in adults with major depressive or anxiety disorders. The primary effect size was calculated from disorder-specific outcome measures as the difference between CBT and pharmacotherapy outcomes (i.e., positive effect size favors CBT; negative effect size favors pharmacotherapy). Results: Twenty-one anxiety (N 5 1,266) and twenty-one depression (N 5 2,027) studies comparing medication to CBT were included. Including all anxiety disorders, the overall effect size was .25 (95% CI: À0.02, 0.55, P 5.07). Effects for panic disorder significantly favored CBT over medications (.50, 95% CI: 0.02, 0.98). Obsessive-compulsive disorder showed similar effects-sizes, though not statistically significant (.49, 95% CI: À0.11, 1.09). Medications showed a nonsignificant advantage for social anxiety disorder (À.22, 95% CI: À0.50, 0.06). The overall effect size for depression studies was .05 (95% CI: À0.09, 0.19), with no advantage for medications or CBT. Pooling anxiety disorder and depression studies, the omnibus comparison of the relative difference between anxiety and depression in effectiveness for CBT versus pharmacotherapy pointed to a nonsignificant advantage for CBT in anxiety versus depression (B 5 .14, 95% CI: À0.14, 0.43). Conclusions: On balance, the evidence presented here indicates that there are at most very modest differences in effects of CBT versus pharmacotherapy in the treatment of anxiety versus depressive disorders. There seems to be larger differences between the anxiety disorders in terms of their relative responsiveness to pharmacotherapy versus CBT. Depression and Anxiety 28:560-567, 2011.

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“…1. Thirty-five studies met inclusion criteria [2][3][4]5,6,8,[15][16][17][18]20,21,24,27,31,33,34,[40][41][42][43]45,46,[50][51][52][53][56][57][58][60][61][62]65,66]. Fig.…”

Section: Selection and Inclusion Of Studiesmentioning

confidence: 99%

The Effects of Blinding on the Outcomes of Psychotherapy and Pharmacotherapy for Adult Depression: a Meta-Analysis

et al. 2015

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BackgroundRandomized trials with antidepressants are often run under double blind placebo-controlled conditions, whereas those with psychotherapies are mostly unblinded. This can introduce bias in favor of psychotherapy when the treatments are directly compared. In this meta-analysis, we examine this potential source of bias.MethodsWe searched Pubmed, PsycInfo, Embase and the Cochrane database (1966 to January 2014) by combining terms indicative of psychological treatment and depression, and limited to randomized trials. We included 35 trials (with 3721 patients) in which psychotherapy and pharmacotherapy for adult depression were directly compared with each other. We calculated effect sizes for each study indicating the difference between psychotherapy and pharmacotherapy at post-test. Then, we examined the difference between studies with a placebo condition and those without in moderator analyses.ResultsWe did not find a significant difference between the studies with and those without a placebo condition. The studies in which a placebo condition was included indicated no significant difference between psychotherapy and pharmacotherapy (g = −0.07; NNT = 25). Studies in which no placebo condition was included (and patients and clinicians in both conditions were not blinded), resulted in a small, but significant difference between psychotherapy and pharmacotherapy in favor of pharmacotherapy (g = −0.13; NNT = 14).ConclusionsStudies comparing psychotherapy and pharmacotherapy in which both groups of patients (and therapists) are not blinded (no placebo condition is included) result in a very small, but significantly higher effect for pharmacotherapy.

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Efficacy of Pharmacotherapy and Cognitive Therapy, alone and in Combination in Major Depressive Disorder

Cited by 12 publications

References 0 publications

Personalized Treatment of Adult Depression: Medication, Psychotherapy, or Both? A Systematic Review

Personalized Treatment of Adult Depression: Medication, Psychotherapy, or Both? A Systematic Review

Relative effects of CBT and pharmacotherapy in depression versus anxiety: is medication somewhat better for depression, and CBT somewhat better for anxiety?

The Effects of Blinding on the Outcomes of Psychotherapy and Pharmacotherapy for Adult Depression: a Meta-Analysis

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