The symptom-specific efficacy of antidepressant medication vs. cognitive behavioral therapy in the treatment of depression: results from an individual patient data meta-analysis

Lynn Boschloo, Ella Bekhuis, Erica S. Weitz, Mirjam Reijnders, Robert J. DeRubeis, Sona Dimidjian, David L. Dunner, Boadie W. Dunlop, Ulrich Hegerl, Steven D. Hollon, Robin B. Jarrett, Sidney H. Kennedy, Jeanne Miranda, David C Mohr, Anne D. Simons, Gordon Parker, Frank Petrak, Stephan Herpertz, Lena C. Quilty, A. John Rush & 4 others Zindel V. Segal, Jeffrey R. Vittengl, Robert A. Schoevers, Pim Cuijpers

Research output: Contribution to JournalArticleAcademicpeer-review

Abstract

A recent individual patient data meta-analysis showed that antidepressant medication is slightly more efficacious than cognitive behavioral therapy (CBT) in reducing overall depression severity in patients with a DSM-defined depressive disorder. We used an update of that dataset, based on seventeen randomized clinical trials, to examine the comparative efficacy of antidepressant medication vs. CBT in more detail by focusing on individual depressive symptoms as assessed with the 17-item Hamilton Rating Scale for Depression. Five symptoms (i.e., “depressed mood”, “feelings of guilt”, “suicidal thoughts”, “psychic anxiety” and “general somatic symptoms”) showed larger improvements in the medication compared to the CBT condition (effect sizes ranging from.13 to.16), whereas no differences were found for the twelve other symptoms. In addition, network estimation techniques revealed that all effects, except that on “depressed mood”, were direct and could not be explained by any of the other direct or indirect treatment effects. Exploratory analyses showed that information about the symptom-specific efficacy could help in identifying those patients who, based on their pre-treatment symptomatology, are likely to benefit more from antidepressant medication than from CBT (effect size of.30) versus those for whom both treatments are likely to be equally efficacious. Overall, our symptom-oriented approach results in a more thorough evaluation of the efficacy of antidepressant medication over CBT and shows potential in “precision psychiatry”.

Original languageEnglish
Pages (from-to)183-191
Number of pages9
JournalWorld Psychiatry
Volume18
Issue number2
DOIs
Publication statusPublished - 1 Jun 2019

Fingerprint

Cognitive Therapy
Antidepressive Agents
Meta-Analysis
Depression
Therapeutics
Guilt
Depressive Disorder
Psychiatry
Emotions
Anxiety
Randomized Controlled Trials

Keywords

  • antidepressant medication
  • cognitive behavioral therapy
  • depressed mood
  • Depression
  • depressive symptoms
  • feelings of guilt
  • general somatic symptoms
  • precision psychiatry
  • psychic anxiety
  • suicidal thoughts

Cite this

Boschloo, Lynn ; Bekhuis, Ella ; Weitz, Erica S. ; Reijnders, Mirjam ; DeRubeis, Robert J. ; Dimidjian, Sona ; Dunner, David L. ; Dunlop, Boadie W. ; Hegerl, Ulrich ; Hollon, Steven D. ; Jarrett, Robin B. ; Kennedy, Sidney H. ; Miranda, Jeanne ; Mohr, David C ; Simons, Anne D. ; Parker, Gordon ; Petrak, Frank ; Herpertz, Stephan ; Quilty, Lena C. ; John Rush, A. ; Segal, Zindel V. ; Vittengl, Jeffrey R. ; Schoevers, Robert A. ; Cuijpers, Pim. / The symptom-specific efficacy of antidepressant medication vs. cognitive behavioral therapy in the treatment of depression : results from an individual patient data meta-analysis. In: World Psychiatry. 2019 ; Vol. 18, No. 2. pp. 183-191.
@article{ef7b36ad9d8b4591b17e7183e157842e,
title = "The symptom-specific efficacy of antidepressant medication vs. cognitive behavioral therapy in the treatment of depression: results from an individual patient data meta-analysis",
abstract = "A recent individual patient data meta-analysis showed that antidepressant medication is slightly more efficacious than cognitive behavioral therapy (CBT) in reducing overall depression severity in patients with a DSM-defined depressive disorder. We used an update of that dataset, based on seventeen randomized clinical trials, to examine the comparative efficacy of antidepressant medication vs. CBT in more detail by focusing on individual depressive symptoms as assessed with the 17-item Hamilton Rating Scale for Depression. Five symptoms (i.e., “depressed mood”, “feelings of guilt”, “suicidal thoughts”, “psychic anxiety” and “general somatic symptoms”) showed larger improvements in the medication compared to the CBT condition (effect sizes ranging from.13 to.16), whereas no differences were found for the twelve other symptoms. In addition, network estimation techniques revealed that all effects, except that on “depressed mood”, were direct and could not be explained by any of the other direct or indirect treatment effects. Exploratory analyses showed that information about the symptom-specific efficacy could help in identifying those patients who, based on their pre-treatment symptomatology, are likely to benefit more from antidepressant medication than from CBT (effect size of.30) versus those for whom both treatments are likely to be equally efficacious. Overall, our symptom-oriented approach results in a more thorough evaluation of the efficacy of antidepressant medication over CBT and shows potential in “precision psychiatry”.",
keywords = "antidepressant medication, cognitive behavioral therapy, depressed mood, Depression, depressive symptoms, feelings of guilt, general somatic symptoms, precision psychiatry, psychic anxiety, suicidal thoughts",
author = "Lynn Boschloo and Ella Bekhuis and Weitz, {Erica S.} and Mirjam Reijnders and DeRubeis, {Robert J.} and Sona Dimidjian and Dunner, {David L.} and Dunlop, {Boadie W.} and Ulrich Hegerl and Hollon, {Steven D.} and Jarrett, {Robin B.} and Kennedy, {Sidney H.} and Jeanne Miranda and David C Mohr and Simons, {Anne D.} and Gordon Parker and Frank Petrak and Stephan Herpertz and Quilty, {Lena C.} and {John Rush}, A. and Segal, {Zindel V.} and Vittengl, {Jeffrey R.} and Schoevers, {Robert A.} and Pim Cuijpers",
year = "2019",
month = "6",
day = "1",
doi = "10.1002/wps.20630",
language = "English",
volume = "18",
pages = "183--191",
journal = "World Psychiatry",
issn = "1723-8617",
publisher = "Masson SpA",
number = "2",

}

Boschloo, L, Bekhuis, E, Weitz, ES, Reijnders, M, DeRubeis, RJ, Dimidjian, S, Dunner, DL, Dunlop, BW, Hegerl, U, Hollon, SD, Jarrett, RB, Kennedy, SH, Miranda, J, Mohr, DC, Simons, AD, Parker, G, Petrak, F, Herpertz, S, Quilty, LC, John Rush, A, Segal, ZV, Vittengl, JR, Schoevers, RA & Cuijpers, P 2019, 'The symptom-specific efficacy of antidepressant medication vs. cognitive behavioral therapy in the treatment of depression: results from an individual patient data meta-analysis' World Psychiatry, vol. 18, no. 2, pp. 183-191. https://doi.org/10.1002/wps.20630

The symptom-specific efficacy of antidepressant medication vs. cognitive behavioral therapy in the treatment of depression : results from an individual patient data meta-analysis. / Boschloo, Lynn; Bekhuis, Ella; Weitz, Erica S.; Reijnders, Mirjam; DeRubeis, Robert J.; Dimidjian, Sona; Dunner, David L.; Dunlop, Boadie W.; Hegerl, Ulrich; Hollon, Steven D.; Jarrett, Robin B.; Kennedy, Sidney H.; Miranda, Jeanne; Mohr, David C; Simons, Anne D.; Parker, Gordon; Petrak, Frank; Herpertz, Stephan; Quilty, Lena C.; John Rush, A.; Segal, Zindel V.; Vittengl, Jeffrey R.; Schoevers, Robert A.; Cuijpers, Pim.

In: World Psychiatry, Vol. 18, No. 2, 01.06.2019, p. 183-191.

Research output: Contribution to JournalArticleAcademicpeer-review

TY - JOUR

T1 - The symptom-specific efficacy of antidepressant medication vs. cognitive behavioral therapy in the treatment of depression

T2 - results from an individual patient data meta-analysis

AU - Boschloo, Lynn

AU - Bekhuis, Ella

AU - Weitz, Erica S.

AU - Reijnders, Mirjam

AU - DeRubeis, Robert J.

AU - Dimidjian, Sona

AU - Dunner, David L.

AU - Dunlop, Boadie W.

AU - Hegerl, Ulrich

AU - Hollon, Steven D.

AU - Jarrett, Robin B.

AU - Kennedy, Sidney H.

AU - Miranda, Jeanne

AU - Mohr, David C

AU - Simons, Anne D.

AU - Parker, Gordon

AU - Petrak, Frank

AU - Herpertz, Stephan

AU - Quilty, Lena C.

AU - John Rush, A.

AU - Segal, Zindel V.

AU - Vittengl, Jeffrey R.

AU - Schoevers, Robert A.

AU - Cuijpers, Pim

PY - 2019/6/1

Y1 - 2019/6/1

N2 - A recent individual patient data meta-analysis showed that antidepressant medication is slightly more efficacious than cognitive behavioral therapy (CBT) in reducing overall depression severity in patients with a DSM-defined depressive disorder. We used an update of that dataset, based on seventeen randomized clinical trials, to examine the comparative efficacy of antidepressant medication vs. CBT in more detail by focusing on individual depressive symptoms as assessed with the 17-item Hamilton Rating Scale for Depression. Five symptoms (i.e., “depressed mood”, “feelings of guilt”, “suicidal thoughts”, “psychic anxiety” and “general somatic symptoms”) showed larger improvements in the medication compared to the CBT condition (effect sizes ranging from.13 to.16), whereas no differences were found for the twelve other symptoms. In addition, network estimation techniques revealed that all effects, except that on “depressed mood”, were direct and could not be explained by any of the other direct or indirect treatment effects. Exploratory analyses showed that information about the symptom-specific efficacy could help in identifying those patients who, based on their pre-treatment symptomatology, are likely to benefit more from antidepressant medication than from CBT (effect size of.30) versus those for whom both treatments are likely to be equally efficacious. Overall, our symptom-oriented approach results in a more thorough evaluation of the efficacy of antidepressant medication over CBT and shows potential in “precision psychiatry”.

AB - A recent individual patient data meta-analysis showed that antidepressant medication is slightly more efficacious than cognitive behavioral therapy (CBT) in reducing overall depression severity in patients with a DSM-defined depressive disorder. We used an update of that dataset, based on seventeen randomized clinical trials, to examine the comparative efficacy of antidepressant medication vs. CBT in more detail by focusing on individual depressive symptoms as assessed with the 17-item Hamilton Rating Scale for Depression. Five symptoms (i.e., “depressed mood”, “feelings of guilt”, “suicidal thoughts”, “psychic anxiety” and “general somatic symptoms”) showed larger improvements in the medication compared to the CBT condition (effect sizes ranging from.13 to.16), whereas no differences were found for the twelve other symptoms. In addition, network estimation techniques revealed that all effects, except that on “depressed mood”, were direct and could not be explained by any of the other direct or indirect treatment effects. Exploratory analyses showed that information about the symptom-specific efficacy could help in identifying those patients who, based on their pre-treatment symptomatology, are likely to benefit more from antidepressant medication than from CBT (effect size of.30) versus those for whom both treatments are likely to be equally efficacious. Overall, our symptom-oriented approach results in a more thorough evaluation of the efficacy of antidepressant medication over CBT and shows potential in “precision psychiatry”.

KW - antidepressant medication

KW - cognitive behavioral therapy

KW - depressed mood

KW - Depression

KW - depressive symptoms

KW - feelings of guilt

KW - general somatic symptoms

KW - precision psychiatry

KW - psychic anxiety

KW - suicidal thoughts

UR - http://www.scopus.com/inward/record.url?scp=85065439585&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85065439585&partnerID=8YFLogxK

U2 - 10.1002/wps.20630

DO - 10.1002/wps.20630

M3 - Article

VL - 18

SP - 183

EP - 191

JO - World Psychiatry

JF - World Psychiatry

SN - 1723-8617

IS - 2

ER -