Are psychological and pharmacologic interventions equally effective in the treatment of adult depressive disorders? A meta-analysis of comparative studies - PubMed (original) (raw)
Review
. 2008 Nov;69(11):1675-85; quiz 1839-41.
doi: 10.4088/jcp.v69n1102. Epub 2008 Aug 12.
Affiliations
- PMID: 18945396
- DOI: 10.4088/jcp.v69n1102
Review
Are psychological and pharmacologic interventions equally effective in the treatment of adult depressive disorders? A meta-analysis of comparative studies
Pim Cuijpers et al. J Clin Psychiatry. 2008 Nov.
Abstract
Objective: A large number of studies suggest that both psychological and pharmacologic therapies are effective in the treatment of mild-to-moderate depressive disorders. Whether both types of intervention are equally effective has not been established definitively.
Data sources: A database was developed through a comprehensive literature search (from 1966 to May 2007) in which 6947 abstracts in PubMed (1244 abstracts), PsycINFO (1736), EMBASE (1911), and the Cochrane Central Register of Controlled Trials (2056) were examined. Abstracts were identified by combining terms indicative of psychological treatment and depression (both MeSH terms and text words). For this database, the primary studies from 22 meta-analyses of psychological treatment for depression were also collected.
Study selection: For the current study, the abstracts of 832 studies were examined.
Data extraction: Thirty randomized trials were included in a meta-analysis that compared the effects of a psychological treatment for 3178 adults with a diagnosed depressive disorder (major depressive disorder, dysthymia, minor depressive disorder) with the effects of a pharmacologic treatment.
Data synthesis: In studies of patients with dysthymia, pharmacotherapy was significantly more effective than psychotherapy (d = -0.28, 95% CI = -0.47 to -0.10). In patients with major depressive disorder, treatments with selective serotonin reuptake inhibitors (SSRIs) were significantly more effective than psychological treatments, while treatment with other antidepressants did not differ significantly. Subgroup and metaregression analyses did not show that pretest severity of depressive symptoms was associated with differential effects of psychological and pharmacologic treatments of major depressive disorder. Dropout rates were smaller in psychological interventions compared with pharmacologic treatments (odds ratio = 0.66, 95% CI = 0.47 to 0.92).
Conclusions: Pharmacologic treatments may be more effective than psychological interventions in the treatment of dysthymia. Pharmacologic treatment with SSRIs may also be more effective in the treatment of major depressive disorder, although these differences are small and probably have little meaning from a clinical point of view. We can conclude that both psychological and pharmacologic therapies are effective in the treatment of depressive disorders and that each has its own merits.
Copyright 2008 Physicians Postgraduate Press, Inc.
Comment in
- Premature conclusions about psychotherapy for dysthymia.
Gaudiano BA, Uebelacker LA, Epstein-Lubow G, Miller IW. Gaudiano BA, et al. J Clin Psychiatry. 2009 Aug;70(8):1188; author reply 1188-89. doi: 10.4088/JCP.09lr05075. J Clin Psychiatry. 2009. PMID: 19758528 No abstract available.
Similar articles
- Adding psychotherapy to pharmacotherapy in the treatment of depressive disorders in adults: a meta-analysis.
Cuijpers P, Dekker J, Hollon SD, Andersson G. Cuijpers P, et al. J Clin Psychiatry. 2009 Sep;70(9):1219-29. doi: 10.4088/JCP.09r05021. J Clin Psychiatry. 2009. PMID: 19818243 - Treatments for later-life depressive conditions: a meta-analytic comparison of pharmacotherapy and psychotherapy.
Pinquart M, Duberstein PR, Lyness JM. Pinquart M, et al. Am J Psychiatry. 2006 Sep;163(9):1493-501. doi: 10.1176/ajp.2006.163.9.1493. Am J Psychiatry. 2006. PMID: 16946172 - Psychotherapy for chronic major depression and dysthymia: a meta-analysis.
Cuijpers P, van Straten A, Schuurmans J, van Oppen P, Hollon SD, Andersson G. Cuijpers P, et al. Clin Psychol Rev. 2010 Feb;30(1):51-62. doi: 10.1016/j.cpr.2009.09.003. Clin Psychol Rev. 2010. PMID: 19781837 - Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis.
Cipriani A, Furukawa TA, Salanti G, Chaimani A, Atkinson LZ, Ogawa Y, Leucht S, Ruhe HG, Turner EH, Higgins JPT, Egger M, Takeshima N, Hayasaka Y, Imai H, Shinohara K, Tajika A, Ioannidis JPA, Geddes JR. Cipriani A, et al. Lancet. 2018 Apr 7;391(10128):1357-1366. doi: 10.1016/S0140-6736(17)32802-7. Epub 2018 Feb 21. Lancet. 2018. PMID: 29477251 Free PMC article. Review. - Selective serotonin reuptake inhibitors and tricyclic antidepressants in the acute treatment of chronic depression and dysthymia: a systematic review and meta-analysis.
von Wolff A, Hölzel LP, Westphal A, Härter M, Kriston L. von Wolff A, et al. J Affect Disord. 2013 Jan 10;144(1-2):7-15. doi: 10.1016/j.jad.2012.06.007. Epub 2012 Sep 7. J Affect Disord. 2013. PMID: 22963896 Review.
Cited by
- European COMPARative Effectiveness research on blended Depression treatment versus treatment-as-usual (E-COMPARED): study protocol for a randomized controlled, non-inferiority trial in eight European countries.
Kleiboer A, Smit J, Bosmans J, Ruwaard J, Andersson G, Topooco N, Berger T, Krieger T, Botella C, Baños R, Chevreul K, Araya R, Cerga-Pashoja A, Cieślak R, Rogala A, Vis C, Draisma S, van Schaik A, Kemmeren L, Ebert D, Berking M, Funk B, Cuijpers P, Riper H. Kleiboer A, et al. Trials. 2016 Aug 3;17(1):387. doi: 10.1186/s13063-016-1511-1. Trials. 2016. PMID: 27488181 Free PMC article. Clinical Trial. - Unhealthy Lifestyle Behaviours and Psychological Distress: A Longitudinal Study of Australian Adults Aged 45 Years and Older.
George ES, Davidson I, El Masri A, Meade T, Kolt GS. George ES, et al. Int J Environ Res Public Health. 2022 Apr 6;19(7):4399. doi: 10.3390/ijerph19074399. Int J Environ Res Public Health. 2022. PMID: 35410079 Free PMC article. - Psychological and pharmacological interventions for depression in patients with coronary artery disease.
Baumeister H, Hutter N, Bengel J. Baumeister H, et al. Cochrane Database Syst Rev. 2011 Sep 7;2011(9):CD008012. doi: 10.1002/14651858.CD008012.pub3. Cochrane Database Syst Rev. 2011. PMID: 21901717 Free PMC article. Updated. Review. - Digital IAPT: the effectiveness & cost-effectiveness of internet-delivered interventions for depression and anxiety disorders in the Improving Access to Psychological Therapies programme: study protocol for a randomised control trial.
Richards D, Duffy D, Blackburn B, Earley C, Enrique A, Palacios J, Franklin M, Clarke G, Sollesse S, Connell S, Timulak L. Richards D, et al. BMC Psychiatry. 2018 Mar 2;18(1):59. doi: 10.1186/s12888-018-1639-5. BMC Psychiatry. 2018. PMID: 29499675 Free PMC article. Clinical Trial. - The promise of cognitive behavior therapy for treatment of severe mental disorders: a review of recent developments.
Thase ME, Kingdon D, Turkington D. Thase ME, et al. World Psychiatry. 2014 Oct;13(3):244-50. doi: 10.1002/wps.20149. World Psychiatry. 2014. PMID: 25273290 Free PMC article.
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Medical