Pim Cuijpers1,2, Eirini Karyotaki1,2, Marketa Ciharova1, Clara Miguel1, Hisashi Noma3, Toshi A Furukawa4. 1. Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands. 2. WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands. 3. Department of Data Science, Institute of Statistical Mathematics, Tokyo, Japan. 4. Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan.
Abstract
OBJECTIVE: Meta-analyses of psychotherapies usually report effects sizes, while clinicians and patients need to know the proportion of patients who benefit from therapy. We conducted a meta-analysis of therapies for depression reporting the rates of response (50% symptom reduction), remission (HAM-D <7), clinical significant deterioration for psychotherapy, and control conditions (CAU, waitlist, and pill placebo), as well as the relative risk of these outcomes and the numbers-needed-to-be-treated (NNTs). METHODS: We searched bibliographic databases and included 228 randomized trials comparing psychotherapy for depression against control conditions (75 with low risk of bias). Only therapies with at least 10 trials were included. We extracted outcomes from the studies, and for those studies not reporting the outcomes, we used a validated method to estimate the rates. RESULTS: The overall response rate in psychotherapies at 2 (±1) months after baseline was 41% (95% CI: 38~43), 17% (15~20) for usual care (CAU), and 16% (95% CI: 14~18) for waitlist. No significant differences between types of therapy were found. The NNT for therapy versus CAU was 5.3 and versus waitlist 3.9. About one third of patients remitted after therapy compared with 7%-13% in control conditions. The rates of deterioration were 5% versus 12%-13%, respectively. Most sensitivity analyses supported the general findings. CONCLUSION: Psychotherapies for depression may be effective compared with control conditions, but more than half of patients receiving therapy do not respond and only one third remitted. More effective treatments and treatment strategies such as sequencing and combining treatments are clearly needed.
OBJECTIVE: Meta-analyses of psychotherapies usually report effects sizes, while clinicians and patients need to know the proportion of patients who benefit from therapy. We conducted a meta-analysis of therapies for depression reporting the rates of response (50% symptom reduction), remission (HAM-D <7), clinical significant deterioration for psychotherapy, and control conditions (CAU, waitlist, and pill placebo), as well as the relative risk of these outcomes and the numbers-needed-to-be-treated (NNTs). METHODS: We searched bibliographic databases and included 228 randomized trials comparing psychotherapy for depression against control conditions (75 with low risk of bias). Only therapies with at least 10 trials were included. We extracted outcomes from the studies, and for those studies not reporting the outcomes, we used a validated method to estimate the rates. RESULTS: The overall response rate in psychotherapies at 2 (±1) months after baseline was 41% (95% CI: 38~43), 17% (15~20) for usual care (CAU), and 16% (95% CI: 14~18) for waitlist. No significant differences between types of therapy were found. The NNT for therapy versus CAU was 5.3 and versus waitlist 3.9. About one third of patients remitted after therapy compared with 7%-13% in control conditions. The rates of deterioration were 5% versus 12%-13%, respectively. Most sensitivity analyses supported the general findings. CONCLUSION: Psychotherapies for depression may be effective compared with control conditions, but more than half of patients receiving therapy do not respond and only one third remitted. More effective treatments and treatment strategies such as sequencing and combining treatments are clearly needed.
Authors: Hannah N Ziobrowski; Ruifeng Cui; Eric L Ross; Howard Liu; Victor Puac-Polanco; Brett Turner; Lucinda B Leung; Robert M Bossarte; Corey Bryant; Wilfred R Pigeon; David W Oslin; Edward P Post; Alan M Zaslavsky; Jose R Zubizarreta; Andrew A Nierenberg; Alex Luedtke; Chris J Kennedy; Ronald C Kessler Journal: Psychol Med Date: 2022-02-11 Impact factor: 10.592
Authors: Falk Leichsenring; Allan Abbass; Nikolas Heim; John R Keefe; Patrick Luyten; Sven Rabung; Christiane Steinert Journal: Front Psychiatry Date: 2022-09-15 Impact factor: 5.435
Authors: Anou Pietrek; Maria Kangas; Reinhold Kliegl; Michael A Rapp; Stephan Heinzel; Jolene van der Kaap-Deeder; Andreas Heissel Journal: Front Psychiatry Date: 2022-09-20 Impact factor: 5.435