Are Psychological and Pharmacologic Interventions Equally Effective in the Treatment of Adult Depressive Disorders?: A Meta-Analysis of Comparative Studies
Abstract
OBJECTIVE: A large number of studies suggest that both psychological and pharmacologic therapies are effective in the treatment of mild-to-moderate depressive disorders. Whether both types of intervention are equally effective has not been established definitively. DATA SOURCES: A database was developed through a comprehensive literature search (from 1966 to May 2007) in which 6947 abstracts in PubMed (1244 abstracts), PsycINFO (1736), EMBASE (1911), and the Cochrane Central Register of Controlled Trials (2056) were examined. Abstracts were identified by combining terms indicative of psychological treatment and depression (both MeSH terms and text words). For this database, the primary studies from 22 meta-analyses of psychological treatment for depression were also collected. STUDY SELECTION: For the current study, the abstracts of 832 studies were examined. DATA EXTRACTION: Thirty randomized trials were included in a meta-analysis that compared the effects of a psychological treatment for 3178 adults with a diagnosed depressive disorder (major depressive disorder, dysthymia, minor depressive disorder) with the effects of a pharmacologic treatment. DATA SYNTHESIS: In studies of patients with dysthymia, pharmacotherapy was significantly more effective than psychotherapy (d = -0.28, 95% CI = -0.47 to -0.10). In patients with major depressive disorder, treatments with selective serotonin reuptake inhibitors (SSRIs) were significantly more effective than psychological treatments, while treatment with other antidepressants did not differ significantly. Subgroup and metaregression analyses did not show that pretest severity of depressive symptoms was associated with differential effects of psychological and pharmacologic treatments of major depressive disorder. Dropout rates were smaller in psychological interventions compared with pharmacologic treatments (odds ratio = 0.66, 95% CI = 0.47 to 0.92). CONCLUSIONS: Pharmacologic treatments may be more effective than psychological interventions in the treatment of dysthymia. Pharmacologic treatment with SSRIs may also be more effective in the treatment of major depressive disorder, although these differences are small and probably have little meaning from a clinical point of view. We can conclude that both psychological and pharmacologic therapies are effective in the treatment of depressive disorders and that each has its own merits.
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In the short-term treatment of depression, psychological and pharmacological therapies have similar efficacy.
“In the short-term treatment of depression, psychological and pharmacological therapies have similar efficacy [171].”
From Brain structural and functional outcomes in the offspring of women experiencing psychological distress during pregnancy (2024) · cites this paper as [171]
Drop-out rates are lower in psychological therapy as compared to pharmacological therapy.
“Drop-out rates are suggested to be lower in psychological therapy as compared to pharmacological therapy [171].”
From Brain structural and functional outcomes in the offspring of women experiencing psychological distress during pregnancy (2024) · cites this paper as [171]
Psychological therapies have proved equally as effective as antidepressants.
“which have proved equally as effective as antidepressants [12]”
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Lorenzo‐Luaces, L., Zimmerman, M. A., & Cuijpers, P. J. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2018.02.066 · Cited by 42 · see citing works
Self-citationErectile Dysfunction and Depression: Screening and Treatment
Perelman, M. A. (2011) · Urologic Clinics of North America · doi:10.1016/j.ucl.2011.03.004 · Cited by 43 · see citing works
Depression and suicidality in COPD: understandable reaction or independent disorders?
Hegerl, U., & Mergl, R. (2014) · European Respiratory Journal · doi:10.1183/09031936.00193213 · Cited by 43 · see citing works
van Bastelaar, K. M. P., Cuijpers, P. J., Pouwer, F., Riper, H. M., & Snoek, F. J. (2010) · Patient Education and Counseling · doi:10.1016/j.pec.2010.06.013 · Cited by 41 · see citing works
Self-citationThe Efficacy of Psychotherapy: Focus on Psychodynamic Psychotherapy as an Example
Levy, K. N., Ehrenthal, J. C., Yeomans, F. E., & Caligor, E. (2014) · Psychodynamic Psychiatry · doi:10.1521/pdps.2014.42.3.377 · Cited by 40 · see citing works
Management of perinatal depression with non-drug interventions
Johansen, S. L., Robakis, T. K., Williams, K. E., & Rasgon, N. (2019) · BMJ · doi:10.1136/bmj.l322 · Cited by 40 · see citing works
Vuorilehto, M. S., Melartin, T. K., Riihimäki, K., & Isometsä, E. T. (2016) · Journal of Affective Disorders · doi:10.1016/j.jad.2016.05.035 · Cited by 36 · see citing works
Richards, D., Timulak, L., Doherty, G., Sharry, J., Colla, A., Joyce, C., & Hayes, C. (2014) · BMC Psychiatry · doi:10.1186/1471-244x-14-147 · Cited by 35 · see citing works
Flückiger, C., Del Re, A. C., Munder, T., Heer, S., & Wampold, B. E. (2014) · Clinical Psychology Review · doi:10.1016/j.cpr.2014.05.001 · Cited by 34 · see citing works
Weitz, E. S., Kleiboer, A. M., van Straten, A., Hollon, S. D., & Cuijpers, P. J. (2017) · BMJ Open · doi:10.1136/bmjopen-2016-013478 · Cited by 36 · see citing works
Self-citationThe changing shape of clinical practice: Driven by science or by pragmatics?
Fonagy, P. (2010) · Psychoanalytic Psychotherapy · doi:10.1080/02668731003590139 · Cited by 27 · see citing works
“Psychotherapy is mostly as effective as psychoactive medication and there is evidence that additional benefit accrues from combining the magics in many contexts (Cuijpers, van Straten, van Oppen, & Andersson, 2008 ; Maina, Rosso, & Bogetto, 2009 ).”
BackgroundChen, S., Ford, T. J., Jones, P. B., & Cardinal, R. N. (2022) · The Lancet Regional Health - Europe · doi:10.1016/j.lanepe.2022.100368 · Cited by 32 · see citing works
Major Depressive Disorder: New Clinical, Neurobiological, and Treatment Perspectives
Kupfer, D. J., Frank, E., & Phillips, M. L. (2014) · FOCUS The Journal of Lifelong Learning in Psychiatry · doi:10.1176/appi.focus.12.2.217 · Cited by 30 · see citing works
Kim, M., Choi, S., Moon, S., Park, H., Hwang, H., Kim, M.-K., & Seok, J. (2020) · 신경정신의학 · doi:10.4306/jknpa.2020.59.1.51 · Cited by 30 · see citing works
Mavranezouli, I., Megnin‐Viggars, O., Pedder, H., Welton, N. J., Dias, S., Watkins, E. R., Nixon, N. L., Daly, C., Keeney, E., Eadon, H., et al. (2024) · EClinicalMedicine · doi:10.1016/j.eclinm.2024.102780 · Cited by 31 · see citing works
Major Depressive Disorder: New Clinical, Neurobiological, and Treatment Perspectives
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“Although these treatments have been shown to be efficacious in reducing symptomology [4,5], it is important to consider the role of nonpharmacological approaches, such as the promotion of healthy lifestyle behaviours, in the prevention and management of mental disorders.”
BackgroundWatanabe, N., Horikoshi, M., Yamada, M., Shimodera, S., Akechi, T., Miki, K., Inagaki, M., Yonemoto, N., Imai, H., Tajika, A., et al. (2015) · Trials · doi:10.1186/s13063-015-0805-z · Cited by 28 · see citing works
“Other effective treatment options for depression include cognitive-behavior therapy (CBT); this has been shown to be as efficacious as pharmacotherapy [5] and to be more efficacious when combined with pharmacotherapy than pharmacotherapy alone [6].”
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“Despite the availability of effective pharmacological and psychological treatments [3], outcome research also indicates that even when treated with evidencebased interventions, MDD remains a highly prevalent [1], usually recurrent [4], and potentially chronic problem [5,6].”
Background
- Authors
- Cuijpers, P., van Straten, A., van Oppen, P., & Andersson, G.
- Affiliations
- Vrije Universiteit Amsterdam (NL)
- Linköping University (SE)
- Venue
- The Journal of Clinical Psychiatry
- Publisher
- Physicians Postgraduate Press, Inc
- Published
- 2008-11-30
- Volume
- 69
- Issue
- 11
- Pages
- 1675-1685
- ISSN
- 0160-6689 (ISSN-L)
- OpenAlex
- W1986628810
- Cited by
- 219
- References
- 0
- Citations by year
- 2026: 5 · 2025: 6 · 2024: 7 · 2023: 6 · 2022: 7 · 2021: 8 · 2020: 5 · 2019: 14 · 2018: 11 · 2017: 14 · 2016: 16 · 2015: 17 · 2014: 25 · 2013: 16 · 2012: 18
- FWCI
- 10.31
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- VU Research Portal (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- 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
- depressive disorders, major depressive disorder, dysthymia, minor depressive disorder, psychotherapy, antidepressants, selective serotonin reuptake inhibitors, treatment effectiveness comparison, dropout rates, symptom severity
- MeSH terms
- Adult, Antidepressive Agents, Major Depressive Disorder, Depressive Disorder, Major, Depressive Disorder, Humans, Patient Dropouts, Psychotherapy, Regression Analysis, Treatment Outcome, Selective Serotonin Reuptake Inhibitors, Dysthymic Disorder
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