EFFICACY AND ACCEPTABILITY OF ACUTE TREATMENTS FOR PERSISTENT DEPRESSIVE DISORDER: A NETWORK META-ANALYSIS
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BACKGROUND: We aimed to synthesize the available evidence on the relative efficacy and acceptability of specific treatments for persistent depressive disorder. METHODS: We searched several databases up to January 2013 and included randomized controlled trials that compared acute pharmacological, psychotherapeutic, and combined interventions with each other or placebo. The outcome measures were the proportion of patients who responded to (efficacy) or dropped out from (acceptability) the allocated treatment. Data synthesis was performed with network meta-analysis. RESULTS: A network of 45 trials that tested 28 drugs included data from 5,806 and 5,348 patients concerning efficacy and acceptability, respectively. A second network of 15 trials that tested five psychotherapeutic and five combined interventions included data from 2,657 and 2,719 patients concerning efficacy and acceptability, respectively. Among sufficiently tested treatments, fluoxetine (odds ratio (OR) 2.94), paroxetine (3.79), sertraline (4.47), moclobemide (6.98), imipramine (4.53), ritanserin (2.35), amisulpride (5.63), and acetyl-l-carnitine (5.67) were significantly more effective than placebo. Pairwise comparisons showed advantages of moclobemide (2.38) and amisulpride (1.92) over fluoxetine. Sertraline (0.57) and amisulpride (0.53) showed a lower dropout rate than imipramine. Interpersonal psychotherapy with medication outperformed medication alone in chronic major depression but not in dysthymia. Evidence on cognitive behavioral analysis system of psychotherapy plus medication was partly inconclusive. Interpersonal psychotherapy was less effective than medication (0.48) and cognitive behavioral analysis system of psychotherapy (0.45). Several other treatments were tested in single studies. CONCLUSIONS: Several evidence-based acute pharmacological, psychotherapeutic, and combined treatments for persistent depressive disorder are available with significant differences between them.
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In persistent depressive disorder (PDD), medication treatment or combination of medication with psychological treatment provides more benefit than psychological treatment alone.
“In persistent depressive disorder (PDD), medication treatment or combination of medication with psychological treatment provides more benefit than psychological treatment alone.12,13”
From Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder (2016) · cites this paper as [13]
The Efficacy and Acceptability of Psychotherapeutic and Combined Treatments section (page not provided) reports that medication was more effective than interpersonal psychotherapy (IPT) alone, and that IPT plus medication was more effective than medication alone at borderline significance. But it found no significant efficacy difference between medication and CBASP, with or without medication. The claim overgeneralizes these treatment-specific findings to psychological treatment alone across PDD. (LLM, conf=0.88)
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Köhler, S., Sterzer, P., Normann, C., Berger, T., & Brakemeier, E. (2016) · Der Nervenarzt
- Authors
- Kriston, L., von Wolff, A., Westphal, A., Hölzel, L. P., & Härter, M.
- Affiliations
- University Medical Center Hamburg-Eppendorf (DE)
- Department of Medical Psychology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
- University Medical Center Freiburg (DE)
- Corresponding author
- Kriston, Levente
- Venue
- Depression and Anxiety
- Publisher
- Hindawi Limited
- Published
- 2014-01-21
- Volume
- 31
- Issue
- 8
- Pages
- 621-630
- ISSN
- 1091-4269 (ISSN-L)
- OpenAlex
- W2166833641
- Semantic Scholar
- 32c3cdf60ef2d9d268358eb9f769ddc846dde721
- Cited by
- 119
- References
- 51
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 6 · 2023: 4 · 2022: 9 · 2021: 12 · 2020: 11 · 2019: 7 · 2018: 14 · 2017: 15 · 2016: 15 · 2015: 13 · 2014: 5
- FWCI
- 2.05
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Depression and Anxiety (publishedVersion, other-oa)
- PubMed (publishedVersion)
- Funders
- German Ministry of Education and Research (01KG0923)
- Topics
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- dysthymia, acute treatment, treatment efficacy, treatment acceptability, dropout, antidepressants, moclobemide, amisulpride, fluoxetine, paroxetine, sertraline, imipramine, interpersonal psychotherapy, CBASP
- MeSH terms
- Humans, Patient Compliance, Treatment Outcome, Depressive Disorder, Treatment-Resistant
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