Psychologic Treatment of Depression Compared With Pharmacotherapy and Combined Treatment in Primary Care: A Network Meta-Analysis

Abstract

PURPOSE Most patients with depression are treated by general practitioners, and most of those patients prefer psychotherapy over pharmacotherapy. No network meta-analyses have examined the effects of psychotherapy compared with pharmacotherapy, combined treatment, care as usual, and other control conditions among patients in primary care. METHODSWe conducted systematic searches of bibliographic databases to identify randomized trials comparing psychotherapy with pharmacotherapy, combined treatment, care as usual, waitlist, and pill placebo. The main outcome was treatment response (50% improvement of depressive symptoms from baseline to end point). RESULTSA total of 58 studies with 9,301 patients were included. Both psychotherapy and pharmacotherapy were significantly more effective than care as usual (relative risk [RR] for response = 1.60; 95% CI, 1.40-1.83 and RR = 1.65; 95% CI, 1.35-2.03, respectively) and waitlist (RR = 2.35; 95% CI, 1.57-3.51 and RR = 2.43; 95% CI, 1.57-3.74, respectively) control groups. We found no significant differences between psychotherapy and pharmacotherapy (RR = 1.03; 95% CI, 0.88-1.22). The effects were significantly greater for combined treatment compared with psychotherapy alone (RR = 1.35; 95% CI, 1.00-1.81). The difference between combined treatment and pharmacotherapy became significant when limited to studies with low risk of bias and studies limited to cognitive behavior therapy. CONCLUSIONS Psychotherapy is likely effective for the treatment of depression when compared with care as usual or waitlist, with effects comparable to those of pharmacotherapy. Combined treatment might be better than either psychotherapy or pharmacotherapy alone.

Availability of two essential medicines for mental health in Bangladesh, the Democratic Republic of Congo, Haiti, Nepal, Malawi, Senegal, and Tanzania: Evidence from nationally representative samples of 7958 health facilities

“…Two challenges to narrowing the global treatment gap include integrating core aspects of mental health services into routine primary health care and improving the supply of effective psychotropic drugs for mental disorders [ 39 ]. Psychotherapy services should ideally be complemented by appropriate and available pharmacotherapy [ 40 ], and primary-care-based treatment of depression and panic disorder using older drugs like amitriptyline has been found to be more cost-effective than the use of newer drugs in LMICs [ 41 ]. Amitriptyline and comparable drugs therefore continue to have an important potential role in LMICs with fewer resources, though the cost of generic selective serotonin reuptake inhibitors (SSRIs) has fallen since 2004 [ 42 ].…”

Exercise as medicine for depressive symptoms? A systematic review and meta-analysis with meta-regression

“…Currently, recommended treatments include psychotherapy and antidepressant medication (or a combination of both) 9. However, psychotherapy achieves remission rates of only 50% while typically being cost-intensive 10. Side effects and relapses from antidepressant medication commonly occur11 as can withdrawal symptoms 12.…”

Psychiatric Psychobiological Treatment Versus Exclusive Psychological Treatment in Depressive Disorders

“…Commonly, for many mental and behavioural disorders, including affective disorders, combined treatment using psychopharmacotherapy and added explicit psychotherapy may be better than either option separately [8], although it is a fact that many people prefer the latter option without using the former. In any case, relatively little is known about which particular groups of patients may respond better to psychiatric treatment -using drugs and psychotherapy, which is generally informal-combined with psychological treatment -psychotherapy alone, either formal or informalversus exclusive treatment, either drug alone or psychological alone [9].…”