Open AccessThe symptom‐specific efficacy of antidepressant medication vs. cognitive behavioral therapy in the treatment of depression: results from an individual patient data meta‐analysis
Author(s) -
Boschloo Lynn,
Bekhuis Ella,
Weitz Erica S.,
Reijnders Mirjam,
DeRubeis Robert J.,
Dimidjian Sona,
Dunner David L.,
Dunlop Boadie W.,
Hegerl Ulrich,
Hollon Steven D.,
Jarrett Robin B.,
Kennedy Sidney H.,
Miranda Jeanne,
Mohr David C.,
Simons Anne D.,
Parker Gordon,
Petrak Frank,
Herpertz Stephan,
Quilty Lena C.,
John Rush A.,
Segal Zindel V.,
Vittengl Jeffrey R.,
Schoevers Robert A.,
Cuijpers Pim
Publication year - 2019
Publication title -
world psychiatry
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 15.51
H-Index - 93
eISSN - 2051-5545
pISSN - 1723-8617
DOI - 10.1002/wps.20630
Subject(s) - medicine , antidepressant , mood , depression (economics) , meta analysis , cognitive behavioral therapy , anxiety , psychiatry , randomized controlled trial , hamilton rating scale for depression , major depressive disorder , clinical psychology , rating scale , psychology , developmental psychology , macroeconomics , economics
A recent individual patient data meta‐analysis showed that antidepressant medication is slightly more efficacious than cognitive behavioral therapy (CBT) in reducing overall depression severity in patients with a DSM‐defined depressive disorder. We used an update of that dataset, based on seventeen randomized clinical trials, to examine the comparative efficacy of antidepressant medication vs. CBT in more detail by focusing on individual depressive symptoms as assessed with the 17‐item Hamilton Rating Scale for Depression. Five symptoms (i.e., “depressed mood” , “feelings of guilt” , “suicidal thoughts” , “psychic anxiety” and “general somatic symptoms”) showed larger improvements in the medication compared to the CBT condition (effect sizes ranging from .13 to .16), whereas no differences were found for the twelve other symptoms. In addition, network estimation techniques revealed that all effects, except that on “depressed mood” , were direct and could not be explained by any of the other direct or indirect treatment effects. Exploratory analyses showed that information about the symptom‐specific efficacy could help in identifying those patients who, based on their pre‐treatment symptomatology, are likely to benefit more from antidepressant medication than from CBT (effect size of .30) versus those for whom both treatments are likely to be equally efficacious. Overall, our symptom‐oriented approach results in a more thorough evaluation of the efficacy of antidepressant medication over CBT and shows potential in “precision psychiatry” .