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Cited by 333Psychotherapy Techniques and ApplicationsMental Health Treatment and AccessPsychological Treatments and Disorders

Efficacy of Pharmacotherapy and Psychotherapy for Adult Psychiatric Disorders: A Systematic Overview of Meta-analyses

Huhn, Maximilian, Tardy, Magdolna, Spineli, Loukia Maria, Kissling, Werner, Förstl, Hans, Pitschel-Walz, Gabriele, Leucht, Claudia, Samara, Myrto +3 more·2014·JAMA Psychiatry
DOI 10.1001/jamapsychiatry.2014.112
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Abstract

IMPORTANCE: There is debate about the effectiveness of psychiatric treatments and whether pharmacotherapy or psychotherapy should be primarily used. OBJECTIVES: To perform a systematic overview on the efficacy of pharmacotherapies and psychotherapies for major psychiatric disorders and to compare the quality of pharmacotherapy and psychotherapy trials. EVIDENCE REVIEW: We searched MEDLINE, EMBASE, PsycINFO, and the Cochrane Library (April 2012, with no time or language limit) for systematic reviews on pharmacotherapy or psychotherapy vs placebo, pharmacotherapy vs psychotherapy, and their combination vs either modality alone. Two reviewers independently selected the meta-analyses and extracted efficacy effect sizes. We assessed the quality of the individual trials included in the pharmacotherapy and psychotherapy meta-analyses with the Cochrane risk of bias tool. FINDINGS: The search yielded 45,233 results. We included 61 meta-analyses on 21 psychiatric disorders, which contained 852 individual trials and 137,126 participants. The mean effect size of the meta-analyses was medium (mean, 0.50; 95% CI, 0.41-0.59). Effect sizes of psychotherapies vs placebo tended to be higher than those of medication, but direct comparisons, albeit usually based on few trials, did not reveal consistent differences. Individual pharmacotherapy trials were more likely to have large sample sizes, blinding, control groups, and intention-to-treat analyses. In contrast, psychotherapy trials had lower dropout rates and provided follow-up data. In psychotherapy studies, wait-list designs showed larger effects than did comparisons with placebo. CONCLUSIONS AND RELEVANCE: Many pharmacotherapies and psychotherapies are effective, but there is a lot of room for improvement. Because of the multiple differences in the methods used in pharmacotherapy and psychotherapy trials, indirect comparisons of their effect sizes compared with placebo or no treatment are problematic. Well-designed direct comparisons, which are scarce, need public funding. Because patients often benefit from both forms of therapy, research should also focus on how both modalities can be best combined to maximize synergy rather than debate the use of one treatment over the other.

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Authors
Huhn, M., Tardy, M., Spineli, L. M., Kissling, W., Förstl, H., Pitschel-Walz, G., Leucht, C., Samara, M., Dold, M., Davis, J. M., & Leucht, S.
Affiliations
  • Technical University of Munich (DE)
  • University of Ioannina (GR)
  • Department of Psychiatry and Psychotherapy, Technische Universität München, München, Germany
  • Warneford Hospital (GB)
  • University of Illinois Chicago (US)
  • King's College London (GB)
ORCID
Venue
JAMA Psychiatry
Publisher
American Medical Association (AMA)
Published
2014-06-01
Volume
71
Issue
6
Pages
706
ISSN
2168-622X (ISSN-L)
DOI
10.1001/jamapsychiatry.2014.112
OpenAlex
W2142253768
Cited by
333
References
89
Citations by year
2026: 13 · 2025: 23 · 2024: 25 · 2023: 23 · 2022: 26 · 2021: 17 · 2020: 34 · 2019: 31 · 2018: 30 · 2017: 28 · 2016: 37 · 2015: 28 · 2014: 18
FWCI
43.65
Type
journal article
Language
en
Open access
closed
Locations
  • JAMA Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • mediaTUM – the media and publications repository of the Technical University Munich (Technical University Munich) (submittedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Disorders
Keywords
pharmacotherapy, psychotherapy, mental illness, treatment efficacy, placebo response, combination therapy, trial quality, risk of bias, effect size
MeSH terms
Adult, Mental Disorders, Combined Modality Therapy, Female, Humans, Male, Psychotherapy, Controlled Clinical Trials as Topic

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