Should Combined CBT, Pharmacotherapy Be Reconsidered in MDD? (Psychiatry Advisor):
“Cognitive behavioral therapy (CBT) alone proved to be superior to the combination of psychotherapy and antidepressant medication in the treatment of major depressive disorder (MDD) in a systematic review and meta-analysis published in Psychological Medicine.
Antidepressant medication is associated with side effects and withdrawal symptoms and 23% more expensive than psychological interventions, which patients often prefer. Evidence has also suggested that CBT and interpersonal psychotherapy (IPT) may be equally effective though little is known about comparisons of CBT and IPT, or either in combination with antidepressant medication … The researchers contend that “considering the superiority of CBT alone and the side-effects, tapering problems and withdrawal symptoms associated with [antidepressant medications], combined treatment should be prescribed carefully, only in complex cases and on a case-by-case basis.”
Towards personalising treatment: a systematic review and meta-analysis of face-to-face efficacy moderators of cognitive-behavioral therapy and interpersonal psychotherapy for major depressive disorder (Psychological Medicine). From the abstract:
- Background: Consistent evidence suggests that face-to-face cognitive-behavioural therapy (CBT) and interpersonal psychotherapy (IPT) may be equally effective depression treatments. Current clinical research focuses on detecting the best predictors-moderators of efficacy to guide treatment personalisation. However, individual moderator studies show inconsistent findings. This systematic review and meta-analysis aimed to compare the efficacy of CBT and IPT, including combined treatment with antidepressants for depression, and evaluate the predictive power of demographic, clinical presentation and treatment characteristics moderators for both therapies.
- Methods: PsycArticles, PsycINFO, PubMed and Cochrane Library were systematically searched through December 2017 for studies that have assessed individuals with major depression receiving either CBT or IPT in a face-to-face format both at pre- and post-treatment. Random-effects moderator meta-analyses were conducted.
- Results: In total 168 samples from 137 studies including 11 374 participants qualified for the meta-analytic review. CBT and IPT were equally effective across all but one prespecified moderators. For psychotherapy delivered without concomitant antidepressant treatment [antidepressant medications (ADMs)], CBT was superior to IPT (g = 1.68, Qbetweenp = 0.037). Within-CBT moderator analyses showed that increased CBT efficacy was associated with lower age, high initial depression severity, individual format of administration and no adjunctive ADMs. Within-IPT analyses showed comparable efficacy across all moderators.
- Conclusions: Clinical guidance around combined treatment (psychotherapy plus ADMs) should be reconsidered. CBT alone is superior to IPT alone and to combined treatment, while IPT alone is non-inferior to combined treatment. More research is needed to assess the moderating effect of older age and number of previous episodes on IPT efficacy.
The Study in Context:
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