When treating depression a treatment package that included psychotherapy and pharmacotherapy was more effective than psychological treatment alone?

  1. National Collaborating Centre for Mental Health (commissioned by the National Institute for Health & Clinical Excellence). Depression: The NICE Guideline on the Treatment and Management of Depression in Adults, updated edition. Leicester & London: British Psychological Society and the Royal College of Psychiatrists; 2004. Available at: http://www.nice.org.uk/nicemedia/live/12329/45896/45896.pdf.

    Google Scholar 

  2. Parikh SV, Segal ZV, Grigoriadis S, Ravindran AV, Kennedy SH, Lam RW, et al. Clinical guidelines for the management of major depressive disorder in adults. II. Psychotherapy alone or in combination with antidepressant medication. J Affect Disord. 2009;117 Suppl 1:S15–25.

    Article  PubMed  Google Scholar 

  3. DGPPN, BÄK, KBV, AWMF, AkdÄ, PPtK, DAGSHG, DEGAM, DGPM, DGPs, DGRW. S3-Leitlinie/Nationale Versorgungleitlinie Unipolare Depression - Langfassung. 2009. Available at: http://www.versorgungsleitlinien.de/themen/depression/pdf/s3_nvl_depression_lang.pdf

  4. Mitchell J, Trangle M, Degnan B, Gabert T, Haight B, Kessler D, et al. Major depression in adults in primary care. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI; 2012.

    Google Scholar 

  5. Barth J, Munder T, Gerger H, Nüesch E, Trelle S, Znoj H, et al. Comparative efficacy of seven psychotherapeutic interventions for patients with depression: a network meta-analysis. PLoS Med. 2013;10:e1001454.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Alonso J, Angermeyer MC, Bernert S, Bruffaerts R, Brugha TS, Bryson H, et al. Disability and quality of life impact of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatr Scand Suppl. 2004;109 Suppl 420:38–46.

    Google Scholar 

  7. Schwenk TL, Coyne JC, Fechner-Bates S. Differences between detected and undetected patients in primary care and depressed psychiatric patients. Gen Hosp Psychiatry. 1996;18:407–15.

    CAS  Article  PubMed  Google Scholar 

  8. Simon GE, Von Korff M. Recognition, management, and outcomes of depression in primary care. Arch Fam Med. 1995;4:99–105.

    CAS  Article  PubMed  Google Scholar 

  9. Kroenke K, Price RK. Symptoms in the community. Prevalence, classification, and psychiatric comorbidity. Arch Intern Med. 1993;153:2474–80.

    CAS  Article  PubMed  Google Scholar 

  10. Williamson PS, Yates WR. The initial presentation of depression in family practice and psychiatric outpatients. Gen Hosp Psychiatry. 1989;11:188–93.

    CAS  Article  PubMed  Google Scholar 

  11. Linde K, Sigterman K, Kriston L, Rücker G, Jamil S, Meissner K, et al. Effectiveness of psychological treatments for depressive disorders in pirmary care: systematic review and meta-analysis. Ann Fam Med. 2015;13:56–68.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Mills EJ, Ioannidis JP, Thorlund K, Schünemann HJ, Puhan MA, Guyatt GH. How to use an article reporting a multiple treatment comparison meta-analysis. JAMA. 2012;308:1246–53.

    CAS  Article  PubMed  Google Scholar 

  13. Salanti G. Indirect and mixed-treatment comparison, network, or multiple-treatments meta-analysis: many names, many benefits, many concerns for the next generation evidence synthesis tool. Res Synth Meth. 2012;3:80–97.

    Article  Google Scholar 

  14. Linde K, Schumann I, Meissner K, Jamil S, Kriston L, Rücker G, et al. Treatment of depressive disorders in primary care--protocol of a multiple treatment systematic review of randomized controlled trials. BMC Fam Pract. 2011;12:127.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Linde K, Kriston L, Rücker G, Jamil S, Schumann I, Meissner K, et al. Efficacy and acceptability of pharmacological treatments for depressive disorders in primary care: systematic review and network-meta-analysis. Ann Fam Med. 2015;13:69–79.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Bortolotti B, Menchetti M, Bellini F, Montaguti MB, Berardi D. Psychological interventions for major depression in primary care: a meta-analytic review of randomized controlled trials. Gen Hosp Psychiatry. 2008;30:293–302.

    Article  PubMed  Google Scholar 

  17. Cuijpers P, van Straten A, van Schaik A, Andersson G. Psychological treatment of depression in primary care: a meta-analysis. Br J Gen Pract. 2009;59:e51–60.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Høifødt RS, Strøm C, Kolstrup N, Eisemann M, Waterloo K. Effectiveness of cognitive behavioural therapy in primary health care: A review. Fam Pract. 2011;28:489–504.

    Article  PubMed  Google Scholar 

  19. Huntley AL, Araya R, Salisbury C. Group psychological therapies for depression in the community: systematic review and meta-analysis. Br J Psychiatry. 2012;200:184–90.

    Article  PubMed  Google Scholar 

  20. Higgins JPT, Altman DG, Sterne JAC. Chapter 8: Assessing risk of bias in included studies. In: Higgins JPT, Green S, eds. Cochrane Handbook for Systematic Reviews of Interventions Version 510 (updated March 2011): The Cochrane Collaboration, 2011

  21. Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ. 2008;337:a1655.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Kriston L. Dealing with clinical heterogeneity in meta-analysis. Assumptions, methods, interpretation. Int J Methods Psychiatr Res. 2013;22:1–15.

    Article  PubMed  Google Scholar 

  23. Furukawa TA, Cipriani A, Barbui C, Brambilla P, Watanabe N. Imputing response rates from means and standard deviations in meta-analyses. Int Clin Psychopharmacol. 2005;20:49–52.

    Article  PubMed  Google Scholar 

  24. Meister R, von Wolff A, Kriston L. Odds ratios of treatment response was well approximated from continuous scale scores for meta-analysis. J Clin Epidemiol. 2015;68:740–51.

    Article  PubMed  Google Scholar 

  25. Senn S, Gavini F, Magrez D, Scheen A. Issues in performing a network meta-analysis. Stat Methods Med Res. 2013;22:169–89.

    Article  PubMed  Google Scholar 

  26. Dias S, Sutton AJ, Ades AE, Welton NJ. Evidence synthesis for decision making 2: a generalized linear modeling framework for pairwise and network meta-analysis of randomized controlled trials. Med Decis Making. 2013;33:607–17.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Krahn U, Binder H, Konig J. A graphical tool for locating inconsistency in network meta-analyses. BMC Med Res Methodol. 2013;13:35.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Rücker G. Network meta-analysis, electrical networks and graph theory. Res Synth Meth. 2012;3:312–24.

    Article  Google Scholar 

  29. Jackson D, White IR, Riley RD. Quantifying the impact of between-study heterogeneity in multivariate meta-analyses. Stat Med. 2012;31:3805–20.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Rücker G, Schwarzer G. Reduce dimension or reduce weights? Comparing two approaches to multi-arm studies in network meta-analysis. Stat Med. 2014;33:4353–69.

    Article  PubMed  Google Scholar 

  31. Dias S, Welton NJ, Sutton AJ, Caldwell DM, Lu G, Ades AE. Evidence synthesis for decision making 4: inconsistency in networks of evidence based on randomized controlled trials. Med Decis Making. 2013;33:641–56.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Dias S, Sutton AJ, Welton NJ, Ades AE. Evidence synthesis for decision making 3: Heterogeneity: subgroups, meta-regression, bias and bias-adjustment. Med Decis Making. 2013;33:618–40.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Mynors-Wallis LM, Gath DH, Lloyd-Thomas AR, Tomlinson D. Randomised controlled trial comparing problem solving treatment with amitriptyline and placebo for major depression in primary care. BMJ. 1995;310:441–5.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  34. Veroniki AA, Mavridis D, Higgins JP, Salanti G. Characteristics of a loop of evidence that affect detection and estimation of inconsistency: a simulation study. BMC Med Res Methodol. 2014;14:106.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Cape J, Whittington C, Buszewicz M, Wallace P, Underwood L. Brief psychological therapies for anxiety and depression in primary care: meta-analysis and meta-regression. BMC Med. 2010;8:38.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Twomey C, O’Reilly G, Byrnec M. Effectiveness of cognitive behavioural therapy for anxiety and depression in primary care: a meta-analysis. Fam Pract. 2015;32:3–15.

    Article  PubMed  Google Scholar 

  37. Cuijpers P, Geraedts AS, van Oppen P, Andersson G, Markowitz JC, van Straten A. Interpersonal psychotherapy for depression: a meta-analysis. Am J Psychiatry. 2011;168:581–92.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Kriston L, von Wolff A, Westphal A, Hölzel LP, Härter M. Efficacy and acceptability of acute treatments for persistent depressive disorder: a network meta-analysis. Depress Anxiety. 2014;31:621–30.

    CAS  Article  PubMed  Google Scholar 

  39. Luce BR, Kramer JM, Goodman SN, Connor JT, Tunis S, Whicher D, et al. Rethinking randomized clinical trials for comparative effectiveness research: the need for transformational change. Ann Intern Med. 2009;151:206–9.

    Article  PubMed  Google Scholar 


Page 2

Skip to main content

From: Comparative effectiveness of psychological treatments for depressive disorders in primary care: network meta-analysis

Median (min., max.) publication year 2006 (1984, 2013)
Patients  
Number of patients  
- Sum 7,024
- Median (min., max.) 143 (29, 707)
Recruitment  
- Clinical 19
- Screening 16
- Mixed 2
Restricted to patients > 55 years 5
Diagnosis  
- Major depression only 14
- Depression (mixed/not exactly specified) 16
- Mild/minor/subthreshold depression and/or dysthymia 7
Overall risk of bias  
- High (high risk in one or more items) 13
- Unclear (no item high risk, < 3 low risk) 11
- Low (at least 3 low, none high risk) 13
Interventions  
Psychological interventions  
- Face-to-face cognitive behavioural psychotherapy (CBT; ≥ 6 sessions) 9
- Face-to-face other problem-solving treatment (PST; ≥ 6 sessions) 5
- Face-to-face interpersonal psychotherapy (≥ 6 sessions) 3
- Face-to-face psychodynamic therapy (≥ 6 sessions) 1
- Other face-to-face psychosocial interventions (≥ 6 sessions) 8
- Remote therapist-led CBT (≥ 6 sessions) 4
- Remote therapist-led PST (≥ 6 sessions) 2
- Guided self-help CBT (up to 4 contacts) 4
- No/minimal contact CBT (less than 30 minutes contact) 4
Pharmacotherapy  
- Selective serotonin reuptake inhibitors (SSRI) 6
- Tricyclic antidepressants 3
- Individualized antidepressant 1
Combinations psychological interventions and pharmacotherapy  
- Face-to-face CBT + SSRI 1
- Face-to-face PST + SSRI 1
- Face-to-face interpersonal therapy + SSRI 1
Contol interventions  
- Placebo 3
- Usual care 27
Median length of treatment in weeks (min., max.) 12 (6, 26)
Median number of treatment sessions (min., max.) 8 (0, 20)
Data available for meta-analysis  
Outcome response 34
Outcome remission 34
Outcome depression score data 36
Outcome total number of patients discontinuing the study 34