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Comparison of psychotherapies for adult depression to pill placebo control groups: a meta-analysis

Published online by Cambridge University Press:  03 April 2013

P. Cuijpers ,
E. H. Turner ,
D. C. Mohr ,
S. G. Hofmann ,
G. Andersson ,
M. Berking  and
J. Coyne
P. Cuijpers*
Affiliation:
Department of Clinical Psychology, VU University Amsterdam, The Netherlands EMGO Institute for Health and Care Research, The Netherlands
E. H. Turner
Affiliation:
Behavioral Health and Neurosciences Division, Portland Veterans Affairs Medical Center, Portland, OR, USA Departments of Psychiatry and Pharmacology, Oregon Health and Science University, Portland, OR, USA
D. C. Mohr
Affiliation:
Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
S. G. Hofmann
Affiliation:
Department of Psychology, Boston University, Boston, MA, USA
G. Andersson
Affiliation:
Department of Behavioral Sciences and Learning, Swedish Institute for Disability Research, Linköping University, Sweden Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institutet, Stockholm, Sweden
M. Berking
Affiliation:
Department of Clinical Psychology, Philipps-University of Marburg, Germany
J. Coyne
Affiliation:
Health Psychology Section, Department of Health Sciences, University Medical Center, Groningen, University of Groningen, The Netherlands
*
*Address for correspondence: P. Cuijpers, Ph.D., Professor of Clinical Psychology, Department of Clinical Psychology, VU University Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands. (Email: p.cuijpers@vu.nl)
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Abstract

Background

The effects of antidepressants for treating depressive disorders have been overestimated because of selective publication of positive trials. Reanalyses that include unpublished trials have yielded reduced effect sizes. This in turn has led to claims that antidepressants have clinically insignificant advantages over placebo and that psychotherapy is therefore a better alternative. To test this, we conducted a meta-analysis of studies comparing psychotherapy with pill placebo.

Method

Ten 10 studies comparing psychotherapies with pill placebo were identified. In total, 1240 patients were included in these studies. For each study, Hedges’ g was calculated. Characteristics of the studies were extracted for subgroup and meta-regression analyses.

Results

The effect of psychotherapy compared to pill placebo at post-test was g = 0.25 [95% confidence interval (CI) 0.14–0.36, I2 = 0%, 95% CI 0–58]. This effect size corresponds to a number needed to treat (NNT) of 7.14 (95% CI 5.00–12.82). The psychotherapy conditions scored 2.66 points lower on the Hamilton Depression Rating Scale (HAMD) than the placebo conditions, and 3.20 points lower on the Beck Depression Inventory (BDI). Some indications for publication bias were found (two missing studies). We found no significant differences between subgroups of the studies and in meta-regression analyses we found no significant association between baseline severity and effect size.

Conclusions

Although there are differences between the role of placebo in psychotherapy and pharmacotherapy research, psychotherapy has an effect size that is comparable to that of antidepressant medications. Whether these effects should be deemed clinically relevant remains open to debate.

Keywords

Depressionmeta-analysisplacebopsychotherapy
Type
Review Article
Information
Psychological Medicine , Volume 44 , Issue 4 , March 2014 , pp. 685 - 695
Copyright
Copyright © Cambridge University Press 2013 

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References

Barber, J, Barrett, MS, Gallop, R, Rynn, MA, Rickels, K (2012). Short-term dynamic psychotherapy versus pharmacotherapy for major depressive disorder: a randomized, placebo-controlled trial. Journal of Clinical Psychiatry 73, 66–73.CrossRefGoogle ScholarPubMed
Barrett, JE, Williams, JW, Oxman, TE, Frank, E, Katon, W, Sullivan, M, Hegel, MT, Cornell, JE, Sengupta, AS (2001). Treatment of dysthymia and minor depression in primary care: a randomized trial in patients aged 18 to 59. Journal of Family Practice 50, 405–412.Google Scholar
Beck, AT, Ward, CH, Mendelson, M, Mock, J, Erbaugh, J (1961). An inventory for measuring depression. Archives of General Psychiatry 4, 561–571.Google Scholar
Borenstein, M, Hedges, LV, Higgins, JPT, Rothstein, HR (2009). Introduction to Meta-Analysis. Wiley: Chichester, UK.Google Scholar
Cuijpers, P, Smit, F, Bohlmeijer, ET, Hollon, SD, Andersson, G (2010 a). Is the efficacy of cognitive behaviour therapy and other psychological treatments for adult depression overestimated? A meta-analytic study of publication bias. British Journal of Psychiatry 196, 173–178.Google Scholar
Cuijpers, P, van Straten, A, Andersson, G, van Oppen, P (2008 a). Psychotherapy for depression in adults: a meta-analysis of comparative outcome studies. Journal of Consulting and Clinical Psychology 76, 909–922.Google Scholar
Cuijpers, P, van Straten, A, Bohlmeijer, E, Hollon, SD, Andersson, G (2010 b). The effects of psychotherapy for adult depression are overestimated: a meta-analysis of study quality and effect size. Psychological Medicine 40, 211–223.Google Scholar
Cuijpers, P, van Straten, A, van Oppen, P, Andersson, G (2008 b). Are psychological and pharmacological interventions equally effective in the treatment of adult depressive disorders? A meta-analysis of comparative studies. Journal of Clinical Psychiatry 69, 1675–1685.Google Scholar
Cuijpers, P, van Straten, A, Warmerdam, L, Andersson, G (2008 c). Psychological treatment of depression: a meta-analytic database of randomized studies. BMC Psychiatry 8, 36.CrossRefGoogle ScholarPubMed
Cuijpers, P, van Straten, A, Warmerdam, L, Smits, N (2008 d). Characteristics of effective psychological treatments of depression: a meta-regression analysis. Psychotherapy Research 18, 225–236.CrossRefGoogle Scholar
David, D, Szentagotai, A, Lupu, V, Cosman, D (2008). Rational emotive behavior therapy, cognitive therapy, and medication in the treatment of major depressive disorder: a randomized clinical trial, posttreatment outcomes, and six month follow-up. Journal of Clinical Psychology 64, 728–746.Google Scholar
DeRubeis, RJ, Hollon, SD, Amsterdam, JD, Shelton, RC, Young, PR, Salomon, RM (2005). Cognitive therapy vs medications in the treatment of moderate to severe depression. Archives of General Psychiatry 62, 409–416.Google Scholar
Dimidjian, S, Hollon, SD, Dobson, KS, Schmaling, KB, Kohlenberg, RJ, Addis, ME (2006). Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression. Journal of Consulting and Clinical Psychology 74, 658–670.CrossRefGoogle ScholarPubMed
Dobson, KS, Hollon, SD, Dimidjian, S, Schmaling, KB, Kohlenberg, RJ, Gallop, RJ, Rizvi, SL, Gollan, JK (2008). Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the prevention of relapse and recurrence in major depression. Journal of Consulting and Clinical Psychology 76, 468–477.Google Scholar
Duval, S, Tweedie, R (2000). Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 56, 455–463.Google Scholar
Dwight-Johnson, M, Sherbourne, CD, Liao, D, Wells, KB (2000). Treatment preferences among depressed primary care patients. Journal of General Internal Medicine 15, 527–534.CrossRefGoogle ScholarPubMed
Elkin, I, Shea, MT, Watkins, JT, Imber, SD, Sotsky, SM, Collins, JF (1989). National Institute of Mental Health Treatment of Depression Collaborative Research Program: general effectiveness of treatments. Archives of General Psychiatry 46, 971–982.Google Scholar
Fournier, JC, DeRubeis, RJ, Hollon, SD, Dimidjian, S, Amsterdam, JD, Shelton, RC (2010). Antidepressant drug effects and depression severity: a patient-level meta-analysis. Journal of the American Medical Association 303, 47–53.Google Scholar
Hamilton, M (1960). A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry 23, 56–62.Google Scholar
Hedges, LV, Olkin, I (1985). Statistical Methods for Meta-Analysis. Academic Press: San Diego, CA.Google Scholar
Hegerl, U, Hautzinger, M, Mergl, R, Kohnen, R, Schütze, M, Scheunemann, W, Allgaier, AK, Coyne, J, Henkel, V (2010). Effects of pharmacotherapy and psychotherapy in depressed primary-care patients: a randomized, controlled trial including a patients’ choice arm. International Journal of Neuropsychopharmacology 13, 31–44.Google Scholar
Higgins, JP, Thompson, SG, Deeks, JJ, Altman, DG (2003). Measuring inconsistency in meta-analyses. British Medical Journal 327, 557–560.CrossRefGoogle ScholarPubMed
Higgins, JPT, Green, S (eds) (2008). Cochrane Handbook for Systematic Reviews of Interventions. Version 5.0.1 [updated September 2008]. Wiley: Chichester, UK.Google Scholar
Hollon, SD, DeRubeis, RJ, Shelton, RC, Amsterdam, JD, Salomon, RM, O'Reardon, JP, Lovett, ML, Young, PR, Haman, KL, Freeman, BB, Gallop, R (2005). Prevention of relapse following cognitive therapy versus medication in moderate to severe depression. Archives of General Psychiatry 62, 417–422.Google Scholar
Hypericum Depression Trial Study Group (2002). Effect of Hypericum perforatum (St John's wort) in major depressive disorder: a randomized controlled trial. Journal of the American Medical Association 287, 1807–1814.Google Scholar
Imel, ZE, Malterer, MB, McKay, KM, Wampold, BE (2008). A meta-analysis of psychotherapy and medication in unipolar depression and dysthymia. Journal of Affective Disorders 110, 197–206.Google Scholar
Ioannidis, JPA, Patsopoulos, NA, Evangelou, E (2007). Uncertainty in heterogeneity estimates in meta-analyses. British Medical Journal 335, 914–916.CrossRefGoogle ScholarPubMed
Jarrett, RB, Schaffer, M, McIntire, D, Witt-Browder, A, Kraft, D, Risser, RC (1999). Treatment of atypical depression with cognitive therapy or phenelzine: a double-blind, placebo-controlled trial. Archives of General Psychiatry 56, 431–437.Google Scholar
Katz, R, Shaw, BF, Vallis, TM, Kaiser, AS (1995). The assessment of severity and symptom patterns in depression. In Handbook of Depression (ed. Beckham, E. E. and Leber, W. R.), 2nd edn, pp. 61–85. Guilford Press: New York.Google Scholar
Kirsch, I (2009). The Emperor's New Drugs: Exploding the Antidepressant Myth. The Bodley Head: London.Google Scholar
Kirsch, I, Deacon, BJ, Huedo-Medina, TB, Scoboria, A, Moore, TJ, Johnson, BT (2008). Initial severity and antidepressant benefits: a meta-analysis of data submitted to the Food and Drug Administration. PLoS Medicine 5, 250–268.Google Scholar
Kraemer, HC, Kupfer, DJ (2006). Size of treatment effects and their importance to clinical research and practice. Biological Psychiatry 59, 990–996.Google Scholar
Laupacis, A, Sackett, DL, Roberts, RS (1988). An assessment of clinically useful measures of the consequences of treatment. New England Journal of Medicine 318, 1728–1733.Google Scholar
Luborsky, L, Diguer, L, Seligman, DA, Rosenthal, R, Krause, ED, Johnson, S, Halperin, G, Bishop, M, Berman, JS, Schweizer, E (1999). The researcher's own therapy allegiances: a ‘wild card’ in comparisons of treatment efficacy. Clinical Psychology: Science and Practice 6, 95–106.Google Scholar
Melander, H, Ahlqvist-Rastad, J, Meijer, G, Beermann, B (2003). Evidence b(i)ased medicine selective reporting from studies sponsored by pharmaceutical industry: review of studies in new drug applications. British Medical Journal 326, 1171–1173.CrossRefGoogle ScholarPubMed
Mohr, DC, Spring, B, Freedland, KE, Beckner, V, Arean, P, Hollon, SD, Ockene, J, Kaplan, R (2009). The selection and design of control conditions for randomized controlled trials of psychological interventions. Psychotherapy and Psychosomatics 78, 275–284.Google Scholar
Mynors-Wallis, LM, Gath, DH, Lloyd-Thomas, AR, Tomlinson, D (1995). Randomised controlled trial comparing problem solving treatment with amitriptyline and placebo for major depression in primary care. British Medical Journal 310, 441–335.Google Scholar
NICE (2004). Depression: management of depression in primary and secondary care. Clinical Practice Guideline CG23. National Institute for Clinical Excellence: London.Google Scholar
Orsini, N, Higgins, J, Bottai, M, Buchan, I (2005). Heterogi: Stata module to quantify heterogeneity in a meta-analysis (http://EconPapers.repec.org/RePEc:boc:bocode:s449201). Accessed 27 February 2013.Google Scholar
Posternak, MA, Zimmerman, M (2007). Therapeutic effect of follow-up assessments on antidepressant and placebo response rates in antidepressant efficacy trials: meta-analysis. British Journal of Psychiatry 190, 287–292.Google Scholar
Rief, W, Nestoriuc, Y, Weiss, S, Welzel, E, Barsky, AJ, Hofmann, SG (2009). Meta-analysis of the placebo response in antidepressant trials. Journal of Affective Disorders 118, 1–9.Google Scholar
Sloane, RB, Staples, FR, Schneider, LS (1985). Interpersonal therapy versus nortriptyline for depression in the elderly. In Clinical and Pharmacological Studies in Psychiatric Disorders (ed. Burrows, G., Norman, T. R. and Dermerstein, L.), pp. 344–346. John Libbey: London.Google Scholar
Temple, R, Ellenberg, SS (2000). Placebo-controlled trials and active-control trials in the evaluation of new treatments. Part 1: Ethical and scientific issues. Annals of Internal Medicine 133, 455–463.Google Scholar
Turner, EH, Matthews, AM, Linardatos, E, Tell, RA, Rosenthal, R (2008). Selective publication of antidepressant trials and its influence on apparent efficacy. New England Journal of Medicine 358, 252–260.Google Scholar
van Schaik, DJF, Klijn, AFJ, van Hout, HPJ, van Marwijk, HWJ, Beekman, ATF, de Haan, M, van Dyck, R (2004). Patients’ preferences in the treatment of depressive disorder in primary care. General Hospital Psychiatry 26, 184–189.Google Scholar
Williams, JW Jr., Barrett, J, Oxman, T, Frank, E, Katon, W, Sullivan, M, Cornell, J, Sengupta, A (2000). Treatment of dysthymia and minor depression in primary care: a randomized controlled trial in older adults. Journal of the American Medical Association 284, 1519–1526.CrossRefGoogle ScholarPubMed
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