Psychologic treatment of depression compared with pharmacotherapy and combined treatment in primary care: A network meta-analysis

P. Cuijpers; M. Oud; E. Karyotaki; H. Noma; S. Quero; A. Cipriani; B. Arroll; T.A. Furukawa

doi:10.1370/afm.2676

Psychologic treatment of depression compared with pharmacotherapy and combined treatment in primary care: A network meta-analysis

P. Cuijpers
, M. Oud
, E. Karyotaki
, H. Noma
, S. Quero
, A. Cipriani
, B. Arroll
, T.A. Furukawa

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

Abstract

PURPOSE Most patients with depression are treated by general practitioners, and most of those patients prefer psychotherapy over pharmacotherapy. No network meta-analyses have examined the effects of psychotherapy compared with pharmacotherapy, combined treatment, care as usual, and other control conditions among patients in primary care.

METHODS We conducted systematic searches of bibliographic databases to identify randomized trials comparing psychotherapy with pharmacotherapy, combined treatment, care as usual, waitlist, and pill placebo. The main outcome was treatment response (50% improvement of depressive symptoms from baseline to end point).

RESULTS A total of 58 studies with 9,301 patients were included. Both psychotherapy and pharmacotherapy were significantly more effective than care as usual (relative risk [RR] for response = 1.60; 95% CI, 1.40-1.83 and RR = 1.65; 95% CI, 1.35-2.03, respectively) and waitlist (RR = 2.35; 95% CI, 1.57-3.51 and RR = 2.43; 95% CI, 1.57-3.74, respectively) control groups. We found no significant differences between psychotherapy and pharmacotherapy (RR = 1.03; 95% CI, 0.88-1.22). The effects were significantly greater for combined treatment compared with psychotherapy alone (RR = 1.35; 95% CI, 1.00-1.81). The difference between combined treatment and pharmacotherapy became significant when limited to studies with low risk of bias and studies limited to cognitive behavior therapy.

CONCLUSIONS Psychotherapy is likely effective for the treatment of depression when compared with care as usual or waitlist, with effects comparable to those of pharmacotherapy. Combined treatment might be better than either psychotherapy or pharmacotherapy alone.

Original language	English
Pages (from-to)	262-270
Number of pages	9
Journal	Annals of Family Medicine
Volume	19
Issue number	3
Early online date	1 May 2021
DOIs	https://doi.org/10.1370/afm.2676
Publication status	Published - Jun 2021

Bibliographical note

Funding

CIBER of Physiopathology of Obesity and Nutrition (CIBERObn), Madrid, Spain (S.Q.); Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom (A.C.); Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom (A.C.); Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand (B.A.); Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/ School of Public Health, Kyoto, Japan (T.A.F.) Acknowledgments: A.C. is supported by the National Institute for Health Research (NIHR) Oxford Cognitive Health Clinical Research Facility; an NIHR Research Professorship (grant RP-2017-08-ST2-006); the NIHR Oxford and Thames Valley Applied Research Collaboration; and the NIHR Oxford Health Biomedical Research Centre (grant BRC-1215-20005). S.Q. is supported by CIBERObn, an initiative of the ISCIII (ISCIII CB06 03/0052). The views expressed are those of the authors and not necessarily those of the UK National Health Service, the NIHR, or the UK Department of Health. A.C. is supported by the National Institute for Health Research (NIHR) Oxford Cognitive Health Clinical Research Facility; an NIHR Research Professorship (grant RP-2017-08-ST2-006); the NIHR Oxford and Thames Valley Applied Research Collaboration; and the NIHR Oxford Health Biomedical Research Centre (grant BRC-1215-20005). S.Q. is supported by CIBERObn, an initiative of the ISCIII (ISCIII CB06 03/0052). The views expressed are those of the authors and not necessarily those of the UK National Health Service, the NIHR, or the UK Department of Health. Mind, Fonds Psychische Gezondheid, and Korrelatie, and for being Chair of the PACO Committee of the Raad voor Civiel-militaire Zorg en Onderzoek of the Dutch Ministry of Defense, and for being Deputy Editor of Depression and Anxiety and Associate Editor of Psychological Bulletin. He also receives royalties for books he has authored or coauthored and for occasional workshops and invited addresses. He received grants from the European Union (FP7 and H2020), ZonMw, and PFGV. T.A.F. reports personal fees from Mitsubishi-Tanabe, MSD, and Shionogi and a grant from Mitsubishi-Tanabe outside the submitted work; T.A.F. has a patent 2018-177688 pending. INCiPiT (Italian Network for Paediatric Trials), A.C. has received research and consultancy fees from INTRODUCTION

Funders	Funder number
Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine
Department of Psychiatry
NIHR Oxford and Thames Valley
National Health Service
Oxford Health NHS Foundation Trust
Warneford Hospital, Oxford
Seventh Framework Programme	H2020
University of Maryland School of Public Health
National Institute for Health Research	RP-2017-08-ST2-006
European Commission
University of Auckland
ZonMw
Instituto de Salud Carlos III	CB06 03/0052
Shionogi
Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición
NIHR Oxford Biomedical Research Centre	BRC-1215-20005

UN SDGs

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

SDG 3 Good Health and Well-being

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Cite this

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title = "Psychologic treatment of depression compared with pharmacotherapy and combined treatment in primary care: A network meta-analysis",

abstract = "PURPOSE Most patients with depression are treated by general practitioners, and most of those patients prefer psychotherapy over pharmacotherapy. No network meta-analyses have examined the effects of psychotherapy compared with pharmacotherapy, combined treatment, care as usual, and other control conditions among patients in primary care. METHODS We conducted systematic searches of bibliographic databases to identify randomized trials comparing psychotherapy with pharmacotherapy, combined treatment, care as usual, waitlist, and pill placebo. The main outcome was treatment response (50\% improvement of depressive symptoms from baseline to end point). RESULTS A total of 58 studies with 9,301 patients were included. Both psychotherapy and pharmacotherapy were significantly more effective than care as usual (relative risk [RR] for response = 1.60; 95\% CI, 1.40-1.83 and RR = 1.65; 95\% CI, 1.35-2.03, respectively) and waitlist (RR = 2.35; 95\% CI, 1.57-3.51 and RR = 2.43; 95\% CI, 1.57-3.74, respectively) control groups. We found no significant differences between psychotherapy and pharmacotherapy (RR = 1.03; 95\% CI, 0.88-1.22). The effects were significantly greater for combined treatment compared with psychotherapy alone (RR = 1.35; 95\% CI, 1.00-1.81). The difference between combined treatment and pharmacotherapy became significant when limited to studies with low risk of bias and studies limited to cognitive behavior therapy. CONCLUSIONS Psychotherapy is likely effective for the treatment of depression when compared with care as usual or waitlist, with effects comparable to those of pharmacotherapy. Combined treatment might be better than either psychotherapy or pharmacotherapy alone.",

author = "P. Cuijpers and M. Oud and E. Karyotaki and H. Noma and S. Quero and A. Cipriani and B. Arroll and T.A. Furukawa",

year = "2021",

month = jun,

doi = "10.1370/afm.2676",

language = "English",

volume = "19",

pages = "262--270",

journal = "Annals of Family Medicine",

issn = "1544-1709",

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T1 - Psychologic treatment of depression compared with pharmacotherapy and combined treatment in primary care

T2 - A network meta-analysis

AU - Cuijpers, P.

AU - Oud, M.

AU - Karyotaki, E.

AU - Noma, H.

AU - Quero, S.

AU - Cipriani, A.

AU - Arroll, B.

AU - Furukawa, T.A.

PY - 2021/6

Y1 - 2021/6

N2 - PURPOSE Most patients with depression are treated by general practitioners, and most of those patients prefer psychotherapy over pharmacotherapy. No network meta-analyses have examined the effects of psychotherapy compared with pharmacotherapy, combined treatment, care as usual, and other control conditions among patients in primary care. METHODS We conducted systematic searches of bibliographic databases to identify randomized trials comparing psychotherapy with pharmacotherapy, combined treatment, care as usual, waitlist, and pill placebo. The main outcome was treatment response (50% improvement of depressive symptoms from baseline to end point). RESULTS A total of 58 studies with 9,301 patients were included. Both psychotherapy and pharmacotherapy were significantly more effective than care as usual (relative risk [RR] for response = 1.60; 95% CI, 1.40-1.83 and RR = 1.65; 95% CI, 1.35-2.03, respectively) and waitlist (RR = 2.35; 95% CI, 1.57-3.51 and RR = 2.43; 95% CI, 1.57-3.74, respectively) control groups. We found no significant differences between psychotherapy and pharmacotherapy (RR = 1.03; 95% CI, 0.88-1.22). The effects were significantly greater for combined treatment compared with psychotherapy alone (RR = 1.35; 95% CI, 1.00-1.81). The difference between combined treatment and pharmacotherapy became significant when limited to studies with low risk of bias and studies limited to cognitive behavior therapy. CONCLUSIONS Psychotherapy is likely effective for the treatment of depression when compared with care as usual or waitlist, with effects comparable to those of pharmacotherapy. Combined treatment might be better than either psychotherapy or pharmacotherapy alone.

AB - PURPOSE Most patients with depression are treated by general practitioners, and most of those patients prefer psychotherapy over pharmacotherapy. No network meta-analyses have examined the effects of psychotherapy compared with pharmacotherapy, combined treatment, care as usual, and other control conditions among patients in primary care. METHODS We conducted systematic searches of bibliographic databases to identify randomized trials comparing psychotherapy with pharmacotherapy, combined treatment, care as usual, waitlist, and pill placebo. The main outcome was treatment response (50% improvement of depressive symptoms from baseline to end point). RESULTS A total of 58 studies with 9,301 patients were included. Both psychotherapy and pharmacotherapy were significantly more effective than care as usual (relative risk [RR] for response = 1.60; 95% CI, 1.40-1.83 and RR = 1.65; 95% CI, 1.35-2.03, respectively) and waitlist (RR = 2.35; 95% CI, 1.57-3.51 and RR = 2.43; 95% CI, 1.57-3.74, respectively) control groups. We found no significant differences between psychotherapy and pharmacotherapy (RR = 1.03; 95% CI, 0.88-1.22). The effects were significantly greater for combined treatment compared with psychotherapy alone (RR = 1.35; 95% CI, 1.00-1.81). The difference between combined treatment and pharmacotherapy became significant when limited to studies with low risk of bias and studies limited to cognitive behavior therapy. CONCLUSIONS Psychotherapy is likely effective for the treatment of depression when compared with care as usual or waitlist, with effects comparable to those of pharmacotherapy. Combined treatment might be better than either psychotherapy or pharmacotherapy alone.

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U2 - 10.1370/afm.2676

DO - 10.1370/afm.2676

M3 - Article

SN - 1544-1709

VL - 19

SP - 262

EP - 270

JO - Annals of Family Medicine

JF - Annals of Family Medicine

IS - 3

ER -

Psychologic treatment of depression compared with pharmacotherapy and combined treatment in primary care: A network meta-analysis

Abstract

Bibliographical note

Funding

UN SDGs

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