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All Psychotherapies Equally Effective for Depression

Summary and Comment |
June 10, 2013

All Psychotherapies Equally Effective for Depression

  1. Peter Roy-Byrne, MD

In a large network meta-analysis, seven psychotherapies show at least small effect sizes compared with control conditions, but almost no differences in head-to-head comparisons.

  1. Peter Roy-Byrne, MD

Few studies have compared different psychotherapies, and neither individual studies nor meta-analyses have yielded conclusive differences between therapies. These authors employed network meta-analysis to use data from direct comparison studies and from analyses that had a comparator in common.

Using 198 studies randomizing 9314 patients with depression or depressed symptoms to psychotherapy and 5805 to control conditions, the researchers calculated effect sizes for multiple psychotherapies (interpersonal, supportive, cognitive-behavioral, behavioral activation, problem solving, social skills, and psychodynamic) compared with each other or with waitlist, usual care, or placebo. For all seven therapies, effects were moderate to large compared with waitlist and (excepting social skills) small to moderate compared with usual care. Compared with one another, the therapies showed no significant differences except that interpersonal therapy was superior to supportive therapy. Effects were not moderated by patient characteristics, but were influenced by study quality and sample size — effects were smaller in higher quality, less biased, and larger studies.

Comment

These results parallel previous findings of comparable effects among different antidepressant medications. It is disappointing that patient characteristics were not linked to improvement with specific psychotherapies, making the goal for “personalized treatment” far off. Given the comparability, cost-effectiveness considerations might argue for using therapies that are briefer, more concrete, and easier to teach than more-complex psychotherapies such as interpersonal and psychodynamic psychotherapies. However, these two therapies had among the larger effect sizes compared with waitlist, and one (interpersonal therapy) had the only significant comparator effect (against supportive therapy), suggesting that these more time-intensive and complex therapies might be targeted toward specific patients, if we knew who they were.

  • Disclosures for Peter Roy-Byrne, MD at time of publication Equity Valant Medical Solutions Grant / research support NIH-NIDA; NIH-NIMH Editorial boards Depression and Anxiety; UpToDate Leadership positions in professional societies Anxiety Disorders Association of America (Ex-Officio Board Member); Washington State Psychiatric Society (Treasurer)

Citation(s):

Reader Comments (2)

Walter Doege, M.D.

The contemporary new interest in the role of psychotherapy in psychiatric treatment is a good surprise for myself. I observe a slow and stead revisit of the effectiveness of psychotherapy in all and any psychiatric and other medical conditions. In relation to severe psychiatric disorders, this article highlits this technique as worthy and effective, although not curative, The major psychiatric disorders are chronic clinical conditions and depressive disorders and major depressive disorders requires appropriate psychiatric treatment (drug treatment, other biological therapies as deep transcranial magnetic stimulation, social, family and community-based care. Although I do not take apart interpersonal from psychodinamic psyhotherapy in this reader remark, the last technique requires more time spent with patient, the results are noticed after two or more years of active treatment, and do require specific skills of a clinical psychiatrist. Also, I observe that this good news open the old fashioned way to work in office based setting. I point out also the underestimation of psychodinamic group psychotherapy (at inpatient and outpatient set). The report is good because Psychiatry is a clinical expertise specialty, the clinician works with no patognomonic findings, and the basic research data from neuroscience and other fields must stand in harmony with ancient evidence of the benefit of taking a patient for treatment and care as an individual, not a disease entity. As mentioned in other reader remark, the results and the psychotherapy process are beneficial to patients and clinical professionals.

Competing interests: None declared

Drsail princeton

It has always been clear that the most progress in abating depression by MD/therapists depends on time spent with patient, interest, and caring. The results are beneficial to patients and professionals, as well

Competing interests: None declared

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