A network meta-analysis of the effects of psychotherapies, pharmacotherapies and their combination in the treatment of adult depression.
Level 1 - systematic review of randomized trials
Systematic review and network meta-analysis of randomized controlled trials
PubMed 31922679 · doi:10.1002/wps.20701
What was done
Systematic searches of bibliographical databases were conducted to identify randomized controlled trials comparing psychotherapy, pharmacotherapy, or their combination for acute or long-term adult depression. The primary outcome was treatment response (≥50% symptom improvement from baseline to endpoint). Remission and acceptability (all-cause study dropout) were also analyzed. Potential moderators included chronic depression, treatment-resistant depression, and baseline severity. Relative risks (RR) were synthesized using a random-effects network meta-analysis.
What was found
Across 101 randomized trials involving 11,910 participants (predominantly moderate to severe depression): - Treatment response: Combined therapy was significantly superior to psychotherapy alone (RR=1.27; 95% CI: 1.14–1.39) and pharmacotherapy alone (RR=1.25; 95% CI: 1.14–1.37). Psychotherapy alone did not differ significantly from pharmacotherapy alone (RR=0.99; 95% CI: 0.92–1.08). - Remission: Yielded patterns similar to response. - Acceptability: Combined treatment (RR=1.23; 95% CI: 1.05–1.45) and psychotherapy alone (RR=1.17; 95% CI: 1.02–1.32) had better acceptability (lower dropout) than pharmacotherapy alone. - Subgroups: Findings were consistent for chronic and treatment-resistant depression.
Why it matters
This large-scale network meta-analysis provides clear evidence that combining psychotherapy with medication offers the greatest clinical benefit in adult depression, while individual monotherapies provide comparable response rates with psychotherapy demonstrating better patient retention.
Limits
The abstract notes a lack of sufficient data on long-term outcomes, cost-effectiveness, specific drug classes or psychotherapy modalities, and outcomes in distinct patient subpopulations.
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