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How Well Do Psychiatric Treatments Work?

Summary and Comment |
May 21, 2014

How Well Do Psychiatric Treatments Work?

  1. Steven Dubovsky, MD

In a “meta-review” of treatment meta-analyses, psychiatric treatment seems to work as well as any medical therapy.

  1. Steven Dubovsky, MD

Little is understood about the effectiveness of pharmacotherapy or psychotherapy compared with each other or with placebo or no treatment. These researchers conducted a systematic review of 61 meta-analyses involving 852 treatment trials of 137,126 patients with 21 psychiatric disorders.

The meta-analyses of placebo or no-treatment comparisons yielded overall a medium effect size for psychiatric treatment (ES; 0.50), with psychotherapy having a somewhat higher one than pharmacotherapy for acute treatment (ESs, 0.58 and 0.40). In 7 meta-analyses of head-to-head comparisons, pharmacotherapy was more effective than dynamic psychotherapy for dysthymia and schizophrenia, and psychotherapy was better for bulimia and relapse prevention of depression. Of 12 meta-analyses of combinations of pharmacotherapy and psychotherapy (range of study participants, 23–2131), 7 found that combination treatment was more effective than either therapy type alone. Maintenance treatment for various disorders had greater effect sizes than acute-phase treatment.

Comment

The marginally greater effect size of psychotherapy studies is probably a function of smaller sample sizes with wider confidence intervals, less-ill patients, fewer blinded assessments, and less use of intent-to-treat analyses, which by including dropouts may more accurately measure “real world” efficacy. Editorialists point out that the medium effect sizes of both pharmacotherapy and psychotherapy are similar to those of most medical therapies. Psychiatric treatment therefore works as well as any medical therapy overall, but more information is needed about what works best for what condition, and in whom.

  • Disclosures for Steven Dubovsky, MD at time of publication Grant / Research support Otsuka; Tower Foundation; Research for Health, Hoffman-La Roche; Pfizer; Takeda Editorial boards Mind and Brain; Bulletin of the Menninger Clinic; Current Psychiatry; Journal of Psychosomatic Research

Citation(s):

Reader Comments (3)

Herman Medow Ph.D. Other Healthcare Professional, Other, Psychology Consultants, Inc.

amazed at the number of truly primitive ":research"articles
dignified as scientific contributions with applications of
sophisticated statistical gymnastics- what enlightenment
does this type of study generate- "psychotherapy" is not
one generic intervention- good contrasting example is
Jeffrey Schwartz' UCLA team design of a therapy protocol
that is a) rooted in history of neuroplasticity research, b) focus
on (f)MRI images of specific brain systems c) specific
psychotherapy protocol to correct deranged brain system
c) assess benefits in terms of biologic changes as well as
reduction/elimination of behavior symptoms

GEORGE JOHN Physician, Critical Care Medicine, HOSPITAL

In other words, words heal as well as chemicals!

Muhammad Arif Malik M.B.B.S. Physician, Family Medicine/General Practice, Lahore Pakistan

Very well concluded by the Editorialists.
One more point to be added that the psychiatric treatments are surely integral part of all medical and post surgical treatments, without this almost no treatment combination may be prove effective .

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