of psychotherapy and combined therapy in the acute treatment of depression. Method: A systematic search was performed for RCTs published between 1980 and 2005 comparing psychotherapy and combined therapy in adult psychiatric outpatients with non-psychotic unipolar major depressive disorder. The studies were classified according to the chronicity and severity of the depression. Data were pooled by means of meta-analysis and statistical tests were conducted to measure heterogeneity. Results: The meta-analysis included seven studies looking at a total of 903 patients. None of the heterogeneity tests established significance. This indicates a lack of evidence for the heterogeneity of the results. The dropout rates did not differ significantly between the two treatment modalities (25% in combined therapy and 24% in psychotherapy, p = 0.77). At treatment termination, the intention-to-treat remission rate for combined therapy (46%) was better than for psychotherapy (34%) (p = 0.0007); Relative Risk 1.32 (95% CI: 1.12-1.56), Odds Ratio 1.59 (95% CI: 1.22-2.09). In moderate depression, the difference between the remission rate for combined therapy and psychotherapy was statistically significant (47% compared to 34% respectively, p = 0.001). This was not the case in mild major depression (42% compared to 37% respectively, p = 0.29). The difference was also statistically significant in chronic major depression (48% compared to 32%, p < 0.001), but not in non-chronic major depression (43% compared to 37%, p = 0.22). On a more specific level, no differences were found in the remission rates for the treatment modalities in mild or moderate non-chronic depression. Combined therapy led to significantly better results than psychotherapy in moderate chronic depression only (48% compared to 32%, p < 0.001). Conclusions: In the acute treatment of adult psychiatric outpatients with major depressive disorder, patient compliance with combined therapy matches compliance with psychotherapy alone. Combined therapy is more efficacious than psychotherapy alone. However, these results depend on severity and chronicity. Combined therapy outperformed psychotherapy in moderate chronic depression only. No differences were found in mild and moderate non-chronic depression. No data were found for mild chronic depression and for severe depression.
De Maat, S. M., Dekker, J., Schoevers, R. A. & de Jonghe, F. (2006). Psychotherapy Research, 16(5), 562-572.
We investigated the efficacy of pharmacotherapy and psychotherapy for depression by searching for RCT's. Studies were classified according to chronicity and severity and a meta-analysis was applied. Ten studies were included. Remission did not differ between psychotherapy (38%) and pharmacotherapy (35%). No differences were found in chronic, or in non-chronic depression, and in mild or in moderate depression. Both treatments performed better in mild than in moderate depression. Dropout was larger in pharmacotherapy (28%) than in psychotherapy (24%). At follow-up relapse in pharmacotherapy (57%) was higher than in psychotherapy (27%). Psychotherapy and pharmacotherapy appear equally efficacious in depression. Both treatments have larger effects in mild than in moderate depression, but similar effects in chronic and nonchronic depression and at follow-up psychotherapy outperforms pharmacotherapy.
de Mello, M. F., de Jesus M. J., Bacaltchuk, J., Verdeli, H. & Neugebauer, R. (2005). European Archives of Psychiatry and Clinical Neuroscience, 255(2), 75-82.
Objective: Interpersonal psychotherapy (IPT) is a time-limited psychotherapy for major depression. The aim of this study is to summarize findings from controlled trials of the efficacy of IPT in the treatment of depressive spectrum disorders (DSD) using a meta-analytic approach.