Biological markers evaluated in randomized trials of psychological treatments for depression: a systematic review and meta-analysis

Ioana A. Cristea; Eirini Karyotaki; Steven D. Hollon; Pim Cuijpers; Claudio Gentili

doi:10.1016/j.neubiorev.2019.03.022

Biological markers evaluated in randomized trials of psychological treatments for depression: a systematic review and meta-analysis

Ioana A. Cristea, Eirini Karyotaki, Steven D. Hollon, Pim Cuijpers, Claudio Gentili^*

^*Corresponding author for this work

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Abstract

Though it is widely believed that psychotherapy changes biology, this contention is largely based on observational data, subject to confounding. We report the first systematic review and meta-analysis of biological variables assessed, as outcomes or predictors of response, in randomized controlled trials of psychotherapy for adult depression. Fifty-one trials (5123 participants) and a pooled analysis were included. Biological markers were outcomes in 43 studies and predictors of treatment response in 9. At post-treatment, psychotherapy could not be distinguished from control conditions for glycaemic control (Hb1AC), 7 trials, Hedges’ g= -.01, 95% CI -0.30 to 0.29, I ² = 65% and cortisol concentration after-wake, 5 trials, Hedges’ g= -.19, 95% CI -0.45 to 0.06, I ² = 0%. Follow-up results were similar. For the other biological domains (immunological, neurobiological, inflammatory, weight, blood pressure), overall findings were mixed and often inconsistent. Few trials investigated prediction of response, with only neuroimaging markers showing promise. Across domains, we found limited evidence that benefits of psychological treatments for depression translate to biological outcomes.

Original language	English
Pages (from-to)	32-44
Number of pages	13
Journal	Neuroscience and Biobehavioral Reviews
Volume	101
Early online date	25 Mar 2019
DOIs	https://doi.org/10.1016/j.neubiorev.2019.03.022
Publication status	Published - Jun 2019

Funding

Ioana A. Cristea was supported for this work by a grant Romanian Ministery of Research and Innovation, CNCS – UEFISCDI (project number PN-III-P1-1.1-TE-2016-1054 ) awarded to Ioana A. Cristea. The funding organization had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Funders	Funder number
Romanian Ministery of Research and Innovation
Corporation for National and Community Service
Unitatea Executiva pentru Finantarea Invatamantului Superior, a Cercetarii, Dezvoltarii si Inovarii	PN-III-P1-1.1-TE-2016-1054

Keywords

Biomarkers
Depression
Meta-analysis
Psychotherapy
Randomized controlled trial

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.neubiorev.2019.03.022

Biological markers evaluated in randomized trials of psychological treatments for depressionFinal published version, 1.77 MBLicence: Article 25fa Dutch Copyright Act

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title = "Biological markers evaluated in randomized trials of psychological treatments for depression: a systematic review and meta-analysis",

abstract = " Though it is widely believed that psychotherapy changes biology, this contention is largely based on observational data, subject to confounding. We report the first systematic review and meta-analysis of biological variables assessed, as outcomes or predictors of response, in randomized controlled trials of psychotherapy for adult depression. Fifty-one trials (5123 participants) and a pooled analysis were included. Biological markers were outcomes in 43 studies and predictors of treatment response in 9. At post-treatment, psychotherapy could not be distinguished from control conditions for glycaemic control (Hb1AC), 7 trials, Hedges{\textquoteright} g= -.01, 95% CI -0.30 to 0.29, I 2 = 65% and cortisol concentration after-wake, 5 trials, Hedges{\textquoteright} g= -.19, 95% CI -0.45 to 0.06, I 2 = 0%. Follow-up results were similar. For the other biological domains (immunological, neurobiological, inflammatory, weight, blood pressure), overall findings were mixed and often inconsistent. Few trials investigated prediction of response, with only neuroimaging markers showing promise. Across domains, we found limited evidence that benefits of psychological treatments for depression translate to biological outcomes. ",

keywords = "Biomarkers, Depression, Meta-analysis, Psychotherapy, Randomized controlled trial",

author = "Cristea, {Ioana A.} and Eirini Karyotaki and Hollon, {Steven D.} and Pim Cuijpers and Claudio Gentili",

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AU - Cuijpers, Pim

AU - Gentili, Claudio

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N2 - Though it is widely believed that psychotherapy changes biology, this contention is largely based on observational data, subject to confounding. We report the first systematic review and meta-analysis of biological variables assessed, as outcomes or predictors of response, in randomized controlled trials of psychotherapy for adult depression. Fifty-one trials (5123 participants) and a pooled analysis were included. Biological markers were outcomes in 43 studies and predictors of treatment response in 9. At post-treatment, psychotherapy could not be distinguished from control conditions for glycaemic control (Hb1AC), 7 trials, Hedges’ g= -.01, 95% CI -0.30 to 0.29, I 2 = 65% and cortisol concentration after-wake, 5 trials, Hedges’ g= -.19, 95% CI -0.45 to 0.06, I 2 = 0%. Follow-up results were similar. For the other biological domains (immunological, neurobiological, inflammatory, weight, blood pressure), overall findings were mixed and often inconsistent. Few trials investigated prediction of response, with only neuroimaging markers showing promise. Across domains, we found limited evidence that benefits of psychological treatments for depression translate to biological outcomes.

AB - Though it is widely believed that psychotherapy changes biology, this contention is largely based on observational data, subject to confounding. We report the first systematic review and meta-analysis of biological variables assessed, as outcomes or predictors of response, in randomized controlled trials of psychotherapy for adult depression. Fifty-one trials (5123 participants) and a pooled analysis were included. Biological markers were outcomes in 43 studies and predictors of treatment response in 9. At post-treatment, psychotherapy could not be distinguished from control conditions for glycaemic control (Hb1AC), 7 trials, Hedges’ g= -.01, 95% CI -0.30 to 0.29, I 2 = 65% and cortisol concentration after-wake, 5 trials, Hedges’ g= -.19, 95% CI -0.45 to 0.06, I 2 = 0%. Follow-up results were similar. For the other biological domains (immunological, neurobiological, inflammatory, weight, blood pressure), overall findings were mixed and often inconsistent. Few trials investigated prediction of response, with only neuroimaging markers showing promise. Across domains, we found limited evidence that benefits of psychological treatments for depression translate to biological outcomes.

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Biological markers evaluated in randomized trials of psychological treatments for depression: a systematic review and meta-analysis

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Keywords

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