Psychological treatment of depression: Results of a series of meta-analyses

Department of Clinical Psychology, VU University Amsterdam, and EMGO Institute, The Netherlands.
Nordic journal of psychiatry (Impact Factor: 1.34). 07/2011; 65(6):354-64. DOI: 10.3109/08039488.2011.596570
Source: PubMed


In the past few decades, a considerable number of studies have examined the effects of psychotherapies for adult depression.
We described the results of a series of meta-analyses examining what this large body of research has contributed to our knowledge of these treatments of depression.
We found that different types of psychotherapy are efficacious in the treatment of adult depression, including cognitive behavior therapy, interpersonal psychotherapy, problem-solving therapy, non-directive supportive therapy and behavioral activation therapy. Differences between types of psychotherapy are small. The efficacy of psychotherapy for mild to moderate depression is about the same as the efficacy of pharmacotherapy, and that combined treatment is more effective than psychotherapy alone and pharmacotherapy alone. Psychotherapy is not only effective in depressed adults in general, but also in older adults, women with postpartum depression, patients with general medical disorders, in inpatients, in primary care patients, patients with chronic depression and in subthreshold depression.
We found no evidence showing that psychotherapy is less efficacious in severe depression (with mean baseline Hamilton Depression Rating Scale scores up to 31, mean Beck Depression Inventory scores up to 35.85 and mean Beck Depression Inventory-II scores up to 36.50), but effects are smaller in chronic depression. We also found that the effects of psychotherapy are probably overestimated because of publication bias and the relatively low quality of many studies in the field.

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Available from: Annemieke van Straten, Oct 29, 2014
    • "Therefore, it is crucial for clinical decision making to identify which therapeutic strategies should be employed to produce the most favorable outcome in the treatment of depression in both the short and the long term. There is ample evidence for the short-term effects of psychotherapies and pharmacological treatments for depression in the acute (aimed at alleviating the symptoms of an active depression ) and the maintenance phase (aimed at preventing future recurrence of the depressive disorder) (Akechi et al., 2008;Beltman et al., 2010;Casacalenda et al., 2002;Cuijpers et al., 2011;Cuijpers and Dekker, 2005;Dennis et al., 2007;Kennedy, 2013;Pizzi et al., 2011;Williams et al., 2000). Meta-analytic studies have shown that, at post-treatment, the effects of psychotherapy and pharmacotherapy in treating mild to moderate depression are comparable (Cuijpers et al., 2013Cuijpers et al., , 2008b), with a combination of pharmacotherapy and psychotherapy showing the best treatment effects when compared to pill placebo, pharmacotherapy and psychotherapy alone (Cuijpers and Dekker, 2005;Cuijpers et al., , 2014Cuijpers et al., , 2012Khan et al., 2012;Pampallona et al., 2004). "
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    ABSTRACT: Background: The present meta-analysis aimed to examine to what extent combined pharmacotherapy with psychotherapy results in a different response to treatment compared to psychotherapy or pharmacotherapy alone in adults with major depression at six months or longer postrandomization. Methods: A systematic literature search resulted in 23 randomized controlled trials with 2184 participants. Combined treatment was compared to either psychotherapy or anti-depressant medication alone in both the acute phase and the maintenance phase. Odds ratios of a positive outcome were calculated for all comparisons. Results: In acute phase treatment, combined psychotherapy with antidepressants outperformed antidepressants alone at six months or longer postrandomization in patients with major depressive disorder (OR=2.93, 95%CI 2.15-3.99, p<0.001). Heterogeneity was zero (95%CI 0-57%, p>0.05). However, combined therapy resulted in equal response to treatment compared to psychotherapy alone at six months or longer postrandomization. As for the maintenance treatment, combined maintenance psychotherapy with antidepressants resulted in better-sustained treatment response compared to antidepressants at six months or longer postrandomization (OR=1.61, 95%CI 1.14-2.27, p<0.05). Heterogeneity was zero (95%CI 0-68%, p>0.05). Conclusions: Combined therapy results in a superior enduring effect compared to antidepressants alone in patients with major depression. Psychotherapy is an adequate alternative for combined treatment in the acute phase as it is as effective as combined treatment in the long-term.
    No preview · Article · Jan 2016 · Journal of Affective Disorders
    • "There is a considerable amount of research evidence from clinical trials suggesting that symptoms of depression and anxiety are relieved and work ability improved in patients treated with short-term psychotherapies, sometimes with relatively well maintained gains during follow-up exceeding one year (Cuijpers et al., 2011, 2014; Town et al., 2012; Abbass et al., 2014). It has also been shown that the effectiveness of short-term psychotherapies of different modalities does not notably differ at the end of the therapy (Barth et al., 2013; Driessen et al., 2013) or after a longer follow-up (Knekt et al., 2008a, 2008b). "
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    ABSTRACT: Both short-term and long-term psychotherapies are used extensively in treating different mental disorders, but there have been practically no attempts to compare their cost-effectiveness. The aim of this study, which is part of the Helsinki Psychotherapy Study, is to assess the cost-effectiveness of two short-term therapies compared to that of a long-term therapy. In this study 326 outpatients suffering from mood or anxiety disorder were randomized to solution-focused therapy (SFT), short-term psychodynamic psychotherapy (SPP) or to long-term psychodynamic psychotherapy (LPP). Psychiatric symptoms and working ability were assessed at baseline and then 4-9 times during a 5-year follow-up using eight widely used measures including e.g. Beck Depression Inventory (BDI), Hamilton Depression Rating Scale (HDRS), Symptom Check List, anxiety scale (SCL-90-Anx), Hamilton Anxiety Rating Scale (HARS), Symptom Check List, Global Severity Index (SCL-90-GSI), and the Work-subscale (SAS-Work) of the Social Adjustment Scale (SAS-SR). Both direct and indirect costs were measured. During the 5-year follow-up period statistically significant improvements were observed in all health indicators in all therapy groups. At first the recovery was faster in the short-term therapy groups than in the LPP group, but taking the whole follow-up period into account, the effectiveness of the LPP was somewhat greater than that of the short-term therapies. Especially the direct costs were, however, much higher in the LPP group than in the short-term therapy groups. Thus the long-term therapy can hardly be regarded as cost-effective compared to short-term therapies when patients are randomized to the therapy groups.
    No preview · Article · Nov 2015 · Journal of Affective Disorders
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    • "These guidelines do not recommend antidepressant medication in patients with mild symptoms. With regard to psychoeducation, it has been demonstrated that it is an effective therapy in the treatment of depression in adults [9] [12], as it reduces depressive symptoms and can prevent depression in primary care patients [13] [14] [15]. It has also been proven to reduce depressive symptoms in mild and moderate depression in both the short term and long term [16] [17] [18] [19]. "
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    ABSTRACT: Background. There is evidence supporting the effectiveness of psychoeducation (PE) in patients with symptoms of depression in primary care (PC), but very few studies have assessed this intervention in antidepressant-na¨ıve patients. The aim of this study is to assess the effectiveness of a PE program in these patients, since the use of antidepressant (AD) medication may interfere with the effects of the intervention. Methods. 106 participants were included, 50 from the PE program (12 weekly 1.5-hour sessions) and 56 from the control group (CG) that received the usual care. Patients were assessed at baseline and at 3, 6, and 9 months. The main outcome measures were the Beck Depression Inventory (BDI) and remission based on the BDI. The analysis was carried out on an intention-to-treat basis. Results. The PE program group showed remission of symptoms of 40% (í µí±ƒ = 0.001) posttreatment and 42% (í µí±ƒ = 0.012) at 6 months. The analysis only showed significant differences in the BDI score posttreatment (í µí±ƒ = 0.008; effect size Cohen's í µí±‘ í® í° = 0.55). Conclusions. The PE intervention is an effective treatment in the depressive population not treated with AD medication. Before taking an AD, psychoeducational intervention should be considered.
    Full-text · Article · Aug 2015 · The Scientific World Journal
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