Psychotherapy versus the combination of psychotherapy and pharmacotherapy in the treatment of depression: a meta-analysis

Abstract

Background: A large number of studies have shown that psychological treatments have significant effects on depression. Although several studies have examined the relative effects of psychological and combined treatments, this has not been studied satisfactorily in recent statistical meta-analyses. Method: We conducted a meta-analysis of randomized studies in which a psychological treatment was compared to a combined treatment consisting of the same psychological treatment with a pharmacological therapy. For each of these studies we calculated the effect size indicating the difference between the psychological and the combined treatment. Results: All inclusion criteria were met by 18 studies, with a total of 1,838 subjects. The mean effect size indicating the difference between psychological and combined treatment was 0.35 (95% CI: 0.24$0.45; Po0.001), with low heterogeneity. Subgroup analyses indicated that the difference between psychological and combined treatments was significantly smaller in studies in which cognitive behavior therapy was examined. We also found a trend (Po0.1) indicating that the difference between psychological and combined treatment was somewhat larger in studies aimed at specific populations (older adults, chronic depression, HIV patients) than in studies with adults, and in studies in which Trycyclic antidepressants or SSRIs were examined, compared to studies in which a medication protocol or another antidepressant was used. At follow-up, no difference between psychological and combined treatments was found. Conclusion: We conclude that combined treatment is more effective than psychological treatment alone. However, it is not clear whether this difference is relevant from a clinical perspective. Depression and Anxiety 26:279-288, 2009.

Psychological treatments are as effective as pharmacotherapies in the treatment of adult depression: a summary from Randomized Clinical Trials and neuroscience evidence

“…This was not significant (P=0.07) but it does indicate that CBT without continuation may be as effective as pharmacotherapy with continuation treatment. Although psychotherapy and pharmacotherapy are probably about equally effective at the short term, there is considerable evidence that at the short term the combination of psychotherapy and pharmacotherapy is more effective than either psychotherapy (Cuijpers, van Straten, Warmerdam, & Andersson, 2009) or pharmacotherapy alone . At the longer term, the odds for a positive outcome at 6 months or longer after randomization is higher in combined treatment compared to pharmacotherapy only (OR=2.72; 95% CI: 1.83 to 4.04; 12 studies) and that is also true at 12 months or longer (OR=2.72; 95% CI: 1.50 to 4.96; 8 studies).…”

Adding Psychotherapy to Pharmacotherapy in the Treatment of Depressive Disorders in Adults

“…The combination of the 2 treatments has been less well-examined, however. A growing body of evidence that combined treatment is more effective than psychotherapy alone [3][4][5] suggests that adding pharmacotherapy has an independent, cumulative effect on depression. Research is less conclusive, however, on the question of whether combined treatment is more effective than pharmacotherapy alone.…”

Efficacité de la psychothérapie comparativement à la pharmacothérapie dans le traitement des troubles anxieux et dépressifs chez l’adulte : une revue de la littérature

“…Les paramètres de résultats examinés ne sont pas présentés de façon détaillée et n'ont pas fait l'objet d'une méta-analyse. Les résultats de la mise à jour réalisée afin de compléter la revue australienne de référence incluaient 12 revues systématiques, y compris les méta-analyses, dont : -2 revues systématiques qui traitent à la fois des troubles dépressifs et des troubles anxieux (Cuijpers et al, 2013 ;Roshanaei-Moghaddam et al, 2011) (Bell & D'Zurilla, 2009 ;Cuijpers, Andersson, Donker, & Van Straten, 2011 ;Cuijpers, Reynolds, et al, 2012 ;Cuijpers, Van Straten, Warmerdam, & Andersson, 2009 ;Gould, Coulson, & Howard, 2012 ;Khan, Faucett, Lichtenberg, Kirsch, & Brown, 2012 ;Spielmans, Berman, & Usitalo, 2011 ;Van Hees, Rotter, Ellermann, & Evers, 2013) incluant environ 138 études avec 18 707 patients ; -et 1 revue systématique qui porte uniquement sur les troubles anxieux (Canton, Scott, & Glue, 2012) incluant 9 ECR totalisant environ 922 patients.…”

“…De même, la revue systématique de Khan et ses collaborateurs (2012) montre que la combinaison des antidépresseurs et de la psychothérapie contribue à une plus grande réduction des symptômes dépressifs et peut procurer un léger avantage par rapport à la psychothérapie seule (p = .022). Dans leur revue systématique de 2011 et 2009, Cuijpers et ses collaborateurs mentionnent également que la combinaison de traitements est plus efficace que la psychothérapie seule dans le traitement des troubles dépressifs (Cuijpers, Clignet, et al, 2011 ;Cuijpers, et al, 2009). La taille de l'effet moyenne concernant la combinaison de la psychothérapie et de la pharmacothérapie est faible (g = 0,35, IC à 95 % : 0,24-0,45 ; p < .001).…”