Comparison of psychotherapies for adult depression to pill placebo control groups

A meta-analysis

P. Cuijpers, Erick Turner, D. C. Mohr, S. G. Hofmann, G. Andersson, M. Berking, J. Coyne

Research output: Contribution to journalReview article

44 Citations (Scopus)

Abstract

Background The effects of antidepressants for treating depressive disorders have been overestimated because of selective publication of positive trials. Reanalyses that include unpublished trials have yielded reduced effect sizes. This in turn has led to claims that antidepressants have clinically insignificant advantages over placebo and that psychotherapy is therefore a better alternative. To test this, we conducted a meta-analysis of studies comparing psychotherapy with pill placebo. Method Ten 10 studies comparing psychotherapies with pill placebo were identified. In total, 1240 patients were included in these studies. For each study, Hedges' g was calculated. Characteristics of the studies were extracted for subgroup and meta-regression analyses. Results The effect of psychotherapy compared to pill placebo at post-test was g = 0.25 [95% confidence interval (CI) 0.14-0.36, I 2 = 0%, 95% CI 0-58]. This effect size corresponds to a number needed to treat (NNT) of 7.14 (95% CI 5.00-12.82). The psychotherapy conditions scored 2.66 points lower on the Hamilton Depression Rating Scale (HAMD) than the placebo conditions, and 3.20 points lower on the Beck Depression Inventory (BDI). Some indications for publication bias were found (two missing studies). We found no significant differences between subgroups of the studies and in meta-regression analyses we found no significant association between baseline severity and effect size. Conclusions Although there are differences between the role of placebo in psychotherapy and pharmacotherapy research, psychotherapy has an effect size that is comparable to that of antidepressant medications. Whether these effects should be deemed clinically relevant remains open to debate.

Original languageEnglish (US)
Pages (from-to)685-695
Number of pages11
JournalPsychological Medicine
Volume44
Issue number4
DOIs
StatePublished - 2014

Fingerprint

Psychotherapy
Meta-Analysis
Placebos
Depression
Control Groups
Antidepressive Agents
Confidence Intervals
Regression Analysis
Numbers Needed To Treat
Publication Bias
Depressive Disorder
Publications
Drug Therapy
Equipment and Supplies
Research

Keywords

  • Depression
  • Meta-analysis
  • Placebo
  • Psychotherapy

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Applied Psychology

Cite this

Comparison of psychotherapies for adult depression to pill placebo control groups : A meta-analysis. / Cuijpers, P.; Turner, Erick; Mohr, D. C.; Hofmann, S. G.; Andersson, G.; Berking, M.; Coyne, J.

In: Psychological Medicine, Vol. 44, No. 4, 2014, p. 685-695.

Research output: Contribution to journalReview article

Cuijpers, P. ; Turner, Erick ; Mohr, D. C. ; Hofmann, S. G. ; Andersson, G. ; Berking, M. ; Coyne, J. / Comparison of psychotherapies for adult depression to pill placebo control groups : A meta-analysis. In: Psychological Medicine. 2014 ; Vol. 44, No. 4. pp. 685-695.
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N2 - Background The effects of antidepressants for treating depressive disorders have been overestimated because of selective publication of positive trials. Reanalyses that include unpublished trials have yielded reduced effect sizes. This in turn has led to claims that antidepressants have clinically insignificant advantages over placebo and that psychotherapy is therefore a better alternative. To test this, we conducted a meta-analysis of studies comparing psychotherapy with pill placebo. Method Ten 10 studies comparing psychotherapies with pill placebo were identified. In total, 1240 patients were included in these studies. For each study, Hedges' g was calculated. Characteristics of the studies were extracted for subgroup and meta-regression analyses. Results The effect of psychotherapy compared to pill placebo at post-test was g = 0.25 [95% confidence interval (CI) 0.14-0.36, I 2 = 0%, 95% CI 0-58]. This effect size corresponds to a number needed to treat (NNT) of 7.14 (95% CI 5.00-12.82). The psychotherapy conditions scored 2.66 points lower on the Hamilton Depression Rating Scale (HAMD) than the placebo conditions, and 3.20 points lower on the Beck Depression Inventory (BDI). Some indications for publication bias were found (two missing studies). We found no significant differences between subgroups of the studies and in meta-regression analyses we found no significant association between baseline severity and effect size. Conclusions Although there are differences between the role of placebo in psychotherapy and pharmacotherapy research, psychotherapy has an effect size that is comparable to that of antidepressant medications. Whether these effects should be deemed clinically relevant remains open to debate.

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