Comparative short-term efficacy and acceptability of a combination of pharmacotherapy and psychotherapy for depressive disorder in children and adolescents: a systematic review and meta-analysis

Yajie Xiang; Pim Cuijpers; Teng Teng; Xuemei Li; Li Fan; Xueer Liu; Yuanliang Jiang; Kang Du; Jingyuan Lin; Xinyu Zhou; Peng Xie

doi:10.1186/s12888-022-03760-2

Comparative short-term efficacy and acceptability of a combination of pharmacotherapy and psychotherapy for depressive disorder in children and adolescents: a systematic review and meta-analysis

Yajie Xiang, Pim Cuijpers, Teng Teng, Xuemei Li, Li Fan, Xueer Liu, Yuanliang Jiang, Kang Du, Jingyuan Lin, Xinyu Zhou, Peng Xie^*

^*Corresponding author for this work

Research output: Contribution to Journal › Article › Academic › peer-review

Abstract

Background: Although the clinical efficacy and safety of combination of pharmacotherapy and psychotherapy in the treatment of depressive disorders in children and adolescents have been studied, the results remain controversial. This meta-analysis aimed to study the short-term efficacy and acceptability of combined therapy for children and adolescents with depressive disorders. Methods: We conducted a systematic search in multiple databases for randomised controlled trials (RCTs), up to 31 December 2020, that assessed the combination of pharmacotherapy and psychotherapy against other active treatment options (pharmacotherapy, psychotherapy and placebo combined psychotherapy) in children and adolescents (≤ 18 years old) with depressive disorder. This study was registered with PROSPERO (CRD42020196701). Results: A total of 14 RCTs involving 1,325 patients were included. For the primary and secondary outcomes, there were no statistically significant differences between the compared interventions in terms of remission (odds ratios [OR] = 1.37; 95% confidence interval [CI]: 0.93 to 2.04), acceptability (OR = 0.99; 95% CI: 0.72 to 1.38), efficacy (standardised mean differences = -0.07; 95% CI: -0.32 to 0.19), and suicidality (OR = 1.17; 95% CI: 0.67 to 2.06). Limited evidence showed that the combination of fluoxetine (OR = 1.90, 95% CI: 1.10 to 3.29) or non-selective serotonin reuptake inhibitors (non-SSRI) (OR = 2.46, 95% CI: 1.06 to 5.72) with cognitive-behavioural therapy (CBT) was superior to other active treatment options. Most included trials were rated as ‘some concerns’ in terms of risk of bias assessment. Conclusion: There is no evidence from the limited available data that all combined therapies are superior to other active treatment options for the acute treatment of depressive disorder in children and adolescents. However, it showed that fluoxetine or non-SSRI pharmacotherapies combined with CBT might be superior to other therapies in short-term. Mixed characteristics (e.g. age) and small sample size of non-SSRI combined therapy may influence the generalisability of the results.

Original language	English
Article number	139
Pages (from-to)	1-13
Number of pages	13
Journal	BMC Psychiatry
Volume	22
DOIs	https://doi.org/10.1186/s12888-022-03760-2
Publication status	Published - 22 Feb 2022

Bibliographical note

Funding Information:
This research was supported by the National Key Research and Development Program of China (Grant No. 2017YFA0505700 to PX), the Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences (Grant No. 2019PT320002 to PX), the National Natural Science Foundation of China (Grant No. 81820108015 to PX), the National Natural Science Foundation of China (Grant No. 81873800 to XZ), the High-level Talents Special Support Plan of Chongqing (Grant No. T04040016 to XZ), the institutional funds from the Chongqing Science and Technology Commission (Grant No. cstc2020jcyj-jqX0024 to XZ).

Publisher Copyright:
© 2022, The Author(s).

Funding

This research was supported by the National Key Research and Development Program of China (Grant No. 2017YFA0505700 to PX), the Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences (Grant No. 2019PT320002 to PX), the National Natural Science Foundation of China (Grant No. 81820108015 to PX), the National Natural Science Foundation of China (Grant No. 81873800 to XZ), the High-level Talents Special Support Plan of Chongqing (Grant No. T04040016 to XZ), the institutional funds from the Chongqing Science and Technology Commission (Grant No. cstc2020jcyj-jqX0024 to XZ).

Funders	Funder number
High-level Talents Special Support Plan of Chongqing	T04040016
Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences	2019PT320002
National Natural Science Foundation of China	81820108015, 81873800
National Natural Science Foundation of China
Chongqing Science and Technology Commission	cstc2020jcyj-jqX0024
Chongqing Science and Technology Commission
National Key Research and Development Program of China	2017YFA0505700
National Key Research and Development Program of China

Keywords

Children and adolescents
Combined therapy
Depressive disorder
Efficacy
Meta-analysis

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10.1186/s12888-022-03760-2

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Xiang, Y., Cuijpers, P., Teng, T., Li, X., Fan, L., Liu, X., Jiang, Y., Du, K., Lin, J., Zhou, X., & Xie, P. (2022). Comparative short-term efficacy and acceptability of a combination of pharmacotherapy and psychotherapy for depressive disorder in children and adolescents: a systematic review and meta-analysis. BMC Psychiatry, 22, 1-13. Article 139. https://doi.org/10.1186/s12888-022-03760-2

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abstract = "Background: Although the clinical efficacy and safety of combination of pharmacotherapy and psychotherapy in the treatment of depressive disorders in children and adolescents have been studied, the results remain controversial. This meta-analysis aimed to study the short-term efficacy and acceptability of combined therapy for children and adolescents with depressive disorders. Methods: We conducted a systematic search in multiple databases for randomised controlled trials (RCTs), up to 31 December 2020, that assessed the combination of pharmacotherapy and psychotherapy against other active treatment options (pharmacotherapy, psychotherapy and placebo combined psychotherapy) in children and adolescents (≤ 18 years old) with depressive disorder. This study was registered with PROSPERO (CRD42020196701). Results: A total of 14 RCTs involving 1,325 patients were included. For the primary and secondary outcomes, there were no statistically significant differences between the compared interventions in terms of remission (odds ratios [OR] = 1.37; 95% confidence interval [CI]: 0.93 to 2.04), acceptability (OR = 0.99; 95% CI: 0.72 to 1.38), efficacy (standardised mean differences = -0.07; 95% CI: -0.32 to 0.19), and suicidality (OR = 1.17; 95% CI: 0.67 to 2.06). Limited evidence showed that the combination of fluoxetine (OR = 1.90, 95% CI: 1.10 to 3.29) or non-selective serotonin reuptake inhibitors (non-SSRI) (OR = 2.46, 95% CI: 1.06 to 5.72) with cognitive-behavioural therapy (CBT) was superior to other active treatment options. Most included trials were rated as {\textquoteleft}some concerns{\textquoteright} in terms of risk of bias assessment. Conclusion: There is no evidence from the limited available data that all combined therapies are superior to other active treatment options for the acute treatment of depressive disorder in children and adolescents. However, it showed that fluoxetine or non-SSRI pharmacotherapies combined with CBT might be superior to other therapies in short-term. Mixed characteristics (e.g. age) and small sample size of non-SSRI combined therapy may influence the generalisability of the results.",

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note = "Funding Information: This research was supported by the National Key Research and Development Program of China (Grant No. 2017YFA0505700 to PX), the Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences (Grant No. 2019PT320002 to PX), the National Natural Science Foundation of China (Grant No. 81820108015 to PX), the National Natural Science Foundation of China (Grant No. 81873800 to XZ), the High-level Talents Special Support Plan of Chongqing (Grant No. T04040016 to XZ), the institutional funds from the Chongqing Science and Technology Commission (Grant No. cstc2020jcyj-jqX0024 to XZ). Publisher Copyright: {\textcopyright} 2022, The Author(s).",

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month = feb,

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Xiang, Y, Cuijpers, P, Teng, T, Li, X, Fan, L, Liu, X, Jiang, Y, Du, K, Lin, J, Zhou, X & Xie, P 2022, 'Comparative short-term efficacy and acceptability of a combination of pharmacotherapy and psychotherapy for depressive disorder in children and adolescents: a systematic review and meta-analysis', BMC Psychiatry, vol. 22, 139, pp. 1-13. https://doi.org/10.1186/s12888-022-03760-2

Comparative short-term efficacy and acceptability of a combination of pharmacotherapy and psychotherapy for depressive disorder in children and adolescents: a systematic review and meta-analysis. / Xiang, Yajie; Cuijpers, Pim; Teng, Teng et al.
In: BMC Psychiatry, Vol. 22, 139, 22.02.2022, p. 1-13.

Research output: Contribution to Journal › Article › Academic › peer-review

TY - JOUR

T1 - Comparative short-term efficacy and acceptability of a combination of pharmacotherapy and psychotherapy for depressive disorder in children and adolescents

T2 - a systematic review and meta-analysis

AU - Xiang, Yajie

AU - Cuijpers, Pim

AU - Teng, Teng

AU - Li, Xuemei

AU - Fan, Li

AU - Liu, Xueer

AU - Jiang, Yuanliang

AU - Du, Kang

AU - Lin, Jingyuan

AU - Zhou, Xinyu

AU - Xie, Peng

N1 - Funding Information: This research was supported by the National Key Research and Development Program of China (Grant No. 2017YFA0505700 to PX), the Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences (Grant No. 2019PT320002 to PX), the National Natural Science Foundation of China (Grant No. 81820108015 to PX), the National Natural Science Foundation of China (Grant No. 81873800 to XZ), the High-level Talents Special Support Plan of Chongqing (Grant No. T04040016 to XZ), the institutional funds from the Chongqing Science and Technology Commission (Grant No. cstc2020jcyj-jqX0024 to XZ). Publisher Copyright: © 2022, The Author(s).

PY - 2022/2/22

Y1 - 2022/2/22

N2 - Background: Although the clinical efficacy and safety of combination of pharmacotherapy and psychotherapy in the treatment of depressive disorders in children and adolescents have been studied, the results remain controversial. This meta-analysis aimed to study the short-term efficacy and acceptability of combined therapy for children and adolescents with depressive disorders. Methods: We conducted a systematic search in multiple databases for randomised controlled trials (RCTs), up to 31 December 2020, that assessed the combination of pharmacotherapy and psychotherapy against other active treatment options (pharmacotherapy, psychotherapy and placebo combined psychotherapy) in children and adolescents (≤ 18 years old) with depressive disorder. This study was registered with PROSPERO (CRD42020196701). Results: A total of 14 RCTs involving 1,325 patients were included. For the primary and secondary outcomes, there were no statistically significant differences between the compared interventions in terms of remission (odds ratios [OR] = 1.37; 95% confidence interval [CI]: 0.93 to 2.04), acceptability (OR = 0.99; 95% CI: 0.72 to 1.38), efficacy (standardised mean differences = -0.07; 95% CI: -0.32 to 0.19), and suicidality (OR = 1.17; 95% CI: 0.67 to 2.06). Limited evidence showed that the combination of fluoxetine (OR = 1.90, 95% CI: 1.10 to 3.29) or non-selective serotonin reuptake inhibitors (non-SSRI) (OR = 2.46, 95% CI: 1.06 to 5.72) with cognitive-behavioural therapy (CBT) was superior to other active treatment options. Most included trials were rated as ‘some concerns’ in terms of risk of bias assessment. Conclusion: There is no evidence from the limited available data that all combined therapies are superior to other active treatment options for the acute treatment of depressive disorder in children and adolescents. However, it showed that fluoxetine or non-SSRI pharmacotherapies combined with CBT might be superior to other therapies in short-term. Mixed characteristics (e.g. age) and small sample size of non-SSRI combined therapy may influence the generalisability of the results.

AB - Background: Although the clinical efficacy and safety of combination of pharmacotherapy and psychotherapy in the treatment of depressive disorders in children and adolescents have been studied, the results remain controversial. This meta-analysis aimed to study the short-term efficacy and acceptability of combined therapy for children and adolescents with depressive disorders. Methods: We conducted a systematic search in multiple databases for randomised controlled trials (RCTs), up to 31 December 2020, that assessed the combination of pharmacotherapy and psychotherapy against other active treatment options (pharmacotherapy, psychotherapy and placebo combined psychotherapy) in children and adolescents (≤ 18 years old) with depressive disorder. This study was registered with PROSPERO (CRD42020196701). Results: A total of 14 RCTs involving 1,325 patients were included. For the primary and secondary outcomes, there were no statistically significant differences between the compared interventions in terms of remission (odds ratios [OR] = 1.37; 95% confidence interval [CI]: 0.93 to 2.04), acceptability (OR = 0.99; 95% CI: 0.72 to 1.38), efficacy (standardised mean differences = -0.07; 95% CI: -0.32 to 0.19), and suicidality (OR = 1.17; 95% CI: 0.67 to 2.06). Limited evidence showed that the combination of fluoxetine (OR = 1.90, 95% CI: 1.10 to 3.29) or non-selective serotonin reuptake inhibitors (non-SSRI) (OR = 2.46, 95% CI: 1.06 to 5.72) with cognitive-behavioural therapy (CBT) was superior to other active treatment options. Most included trials were rated as ‘some concerns’ in terms of risk of bias assessment. Conclusion: There is no evidence from the limited available data that all combined therapies are superior to other active treatment options for the acute treatment of depressive disorder in children and adolescents. However, it showed that fluoxetine or non-SSRI pharmacotherapies combined with CBT might be superior to other therapies in short-term. Mixed characteristics (e.g. age) and small sample size of non-SSRI combined therapy may influence the generalisability of the results.

KW - Children and adolescents

KW - Combined therapy

KW - Depressive disorder

KW - Efficacy

KW - Meta-analysis

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Comparative short-term efficacy and acceptability of a combination of pharmacotherapy and psychotherapy for depressive disorder in children and adolescents: a systematic review and meta-analysis

Abstract

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