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Study: To treat depression, therapy alone works better than therapy combined with antidepressants

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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.”

The Study:

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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