Adding Psychotherapy to Pharmacotherapy in the Treatment of Depressive Disorders in Adults: A Meta-Analysis
Open accessAbstract
OBJECTIVE: A considerable number of studies has examined whether adding psychotherapy to pharmacotherapy results in stronger effects than pharmacotherapy alone. However, earlier meta-analyses in this field have included only a limited number of available studies and did not conduct extended subgroup analyses to examine possible sources of heterogeneity. DATA SOURCES: We used a database derived from a comprehensive literature search in PubMed, PsycINFO, EMBASE, and the Cochrane Central Register of Controlled Trials for studies published from 1966 to January 2008 that examined the psychological treatment of depression. The abstracts of these studies were identified by combining terms indicative of psychological treatment and depression. STUDY SELECTION: We included randomized trials in which the effects of a pharmacologic treatment were compared to the effects of a combined pharmacologic and psychological treatment in adults with a depressive disorder. DATA EXTRACTION: For each of the studies, we calculated a standardized mean effect size indicating the difference between pharmacotherapy and the combined treatment at posttest. We also coded major characteristics of the population, the interventions, and the quality and design of the study. DATA SYNTHESIS: Twenty-five randomized trials, with a total of 2,036 patients, were included. A mean effect size of d = 0.31 (95% CI, 0.20 approximately 0.43) was found for the 25 included studies, indicating a small effect in favor of the combined treatment over pharmacotherapy alone. Studies aimed at patients with dysthymia resulted in significantly lower effect sizes compared to studies aimed at patients with major depression, a finding that suggests that the added value of psychotherapy is less in patients with dysthymia. The dropout rate was significantly lower in the combined treatment group compared to the pharmacotherapy only group (OR = 0.65; 95% CI, 0.50 approximately 0.83). CONCLUSIONS: Psychotherapy seems to have an additional value compared to pharmacotherapy alone for depression.
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Internet-delivered psychological interventions have the potential to overcome environmental and economic barriers to the provision of evidence-based psychological treatment in the Irish health service context.
“Internet-delivered psychological interventions among people with chronic pain have the potential to overcome environmental and economic barriers to the provision of evidence-based psychological treatment in the Irish health service context.”
From Comparing the clinical-effectiveness and cost-effectiveness of an internet-delivered Acceptance and Commitment Therapy (ACT) intervention with a waiting list control among adults with chronic pain: study protocol for a randomised controlled trial (2014) · cites this paper as [27]
The Study Selection passage (p. 2) describes trials comparing pharmacotherapy with combined pharmacotherapy and psychotherapy for adults with depressive disorders. The Discussion (p. 11) addresses the added value of psychotherapy for depression, but neither passage addresses internet-delivered treatment for chronic pain or its potential to overcome environmental and economic barriers in the Irish health service. Searches for internet delivery, chronic pain, Ireland, and access barriers found no relevant passage. (LLM, conf=0.76)
Experimental — accuracy not yet measuredInternet-delivered psychological therapy aims to increase access to psychological intervention.
“One approach that aims to increase access to psychological intervention which has received increased attention in recent years is internet-delivered psychological therapy.22 24 26–30”
From Comparing the clinical-effectiveness and cost-effectiveness of an internet-delivered Acceptance and Commitment Therapy (ACT) intervention with a waiting list control among adults with chronic pain: study protocol for a randomised controlled trial (2014) · cites this paper as [27]
The Objective and Study Selection passages (p. 2) describe a meta-analysis of adding psychotherapy to pharmacotherapy for depression. The Characteristics of the Included Studies (p. 4) list therapy types but do not address internet delivery or access to care. Searches for internet-delivered therapy, online treatment, and access found no passage supporting the attributed point. (LLM, conf=0.74)
Experimental — accuracy not yet measuredSome 750 trials with over 30,000 participants provide evidence for various psychotherapies for the acute treatment of major depression, and more than 500 trials involving over 110,000 participants provide support for the efficacy of antidepressants.
“Some 750 trials with over 30,000 participants provide evidence for various psychotherapies for the acute treatment of major depression, 505 and more than 500 trials involving over 110,000 participants provide support for the efficacy of antidepressants. 506”
From Time for united action on depression: a Lancet–World Psychiatric Association Commission (2022) · cites this paper as [505]
There have been no discernible differences detected so far among different psychotherapies.
“There have been no discernible differences detected so far among different psychotherapies. 505”
From Time for united action on depression: a Lancet–World Psychiatric Association Commission (2022) · cites this paper as [505]
Depression can be treated effectively with different forms of psychotherapies.
“depression can be treated effectively with different forms of psychotherapies [13-18]”
From Long-Term Results of a Web-Based Guided Self-Help Intervention for Employees With Depressive Symptoms: Randomized Controlled Trial (2014) · cites this paper as [14]
Research on the treatment of depression has been extensive.
“Research on the treatment of depression has been extensive [13-16] and many studies have shown positive effects of different psychotherapies (eg, [15,17,18]).”
From Short-Term Effects of a Web-Based Guided Self-Help Intervention for Employees With Depressive Symptoms: Randomized Controlled Trial (2014) · cites this paper as [14]
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Dropout from outpatient mental health care: results from the Israel National Health Survey
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- Authors
- Cuijpers, P., Dekker, J., Hollon, S. D., & Andersson, G.
- Affiliations
- Vrije Universiteit Amsterdam (NL)
- Corresponding author
- Cuijpers, Pim
- Venue
- The Journal of Clinical Psychiatry
- Publisher
- Physicians Postgraduate Press, Inc
- Published
- 2009-09-15
- Volume
- 70
- Issue
- 9
- Pages
- 1219-1229
- ISSN
- 0160-6689 (ISSN-L)
- OpenAlex
- W2150358535
- Cited by
- 261
- References
- 45
- Citations by year
- 2026: 9 · 2025: 9 · 2024: 9 · 2023: 13 · 2022: 14 · 2021: 13 · 2020: 10 · 2019: 19 · 2018: 13 · 2017: 12 · 2016: 23 · 2015: 20 · 2014: 22 · 2013: 15 · 2012: 14
- FWCI
- 21.27
- Type
- journal article
- Language
- en
- Open access
- green
- research.vu.nl
- Licence
- other-oa
- Locations
- The Journal of Clinical Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- VU Research Portal (publishedVersion, other-oa)
- Digital Academic REpository of VU University Amsterdam (Vrije Universiteit Amsterdam) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Funders
- Vanderbilt University
- Vrije Universiteit Amsterdam
- Linköpings Universitet
- Karolinska Institutet
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- depression, psychotherapy, pharmacotherapy, combined psychotherapy and pharmacotherapy, major depressive disorder, dysthymia, treatment discontinuation, treatment effect size, adults
- MeSH terms
- Adult, Antidepressive Agents, Combined Modality Therapy, Major Depressive Disorder, Depressive Disorder, Major, Depressive Disorder, Humans, Patient Dropouts, Psychotherapy, Randomized Controlled Trials as Topic, Treatment Outcome, Selective Serotonin Reuptake Inhibitors, Dysthymic Disorder
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