| 1. |
- Breedvelt, Josefien J. F., et al.
(författare)
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An individual participant data meta-analysis of psychological interventions for preventing depression relapse
- 2024
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Ingår i: Nature Mental Health. - 2731-6076. ; 2:2, s. 154-163
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Tidskriftsartikel (refereegranskat)abstract
- Major depressive disorder is a leading cause of disability worldwide; identifying effective strategies to prevent depression relapse is crucial. This individual participant data meta-analysis addresses whether and for whom psychological interventions can be recommended for relapse prevention of major depressive disorder. One- and two-stage individual patient data meta-analyses were conducted on 14 randomized controlled trials (N = 1,720). The relapse risk over 12 months was substantially lower for those who received a psychological intervention versus treatment as usual, antidepressant medication, or evaluation-only control (hazard ratio, 0.60; 95% confidence interval, 0.48–0.74). The number of previous depression episodes moderated the treatment effect, with psychological interventions demonstrating greater efficacy for patients with three or more previous episodes. Our results suggest that adding psychological interventions to current treatment to prevent depression relapse is recommended. For patients at lower risk of relapse, less-intensive approaches may be indicated.
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| 2. |
- Cuijpers, Pim, et al.
(författare)
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Are Psychological and Pharmacologic Interventions Equally Effective in the Treatment of Adult Depressive Disorders? : A Meta-Analysis of Comparative Studies
- 2008
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Ingår i: Journal of Clinical Psychiatry. - 0160-6689 .- 1555-2101. ; 69:11, s. 1675-1685
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Tidskriftsartikel (refereegranskat)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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| 3. |
- Cuijpers, Pim, et al.
(författare)
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Interpersonal Psychotherapy for Depression: A Meta-Analysis
- 2011
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Ingår i: AMERICAN JOURNAL OF PSYCHIATRY. - : American Psychiatric Association. - 0002-953X .- 1535-7228. ; 168:6, s. 581-592
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Forskningsöversikt (refereegranskat)abstract
- Objective: Interpersonal psychotherapy (IPT), a structured and time-limited therapy, has been studied in many controlled trials. Numerous practice guidelines have recommended IPT as a treatment of choice for unipolar depressive disorders. The authors conducted a meta-analysis to integrate research on the effects of IPT. Method: The authors searched bibliographical databases for randomized controlled trials comparing IPT with no treatment, usual care, other psychological treatments, and pharmacotherapy as well as studies comparing combination treatment using pharmacotherapy and IPT. Maintenance studies were also included. Results: Thirty-eight studies including 4,356 patients met all inclusion criteria. The overall effect size (Cohens d) of the 16 studies that compared IPT and a control group was 0.63 (95% confidence interval [CI]=0.36 to 0.90), corresponding to a number needed to treat of 2.91. Ten studies comparing IPT and other psychological treatments showed a nonsignificant differential effect size of 0.04 (95% CI=-0.14 to 0.21; number needed to treat=45.45) favoring IPT. Pharmacotherapy (after removal of one outlier) was more effective than IPT (d=-0.19, 95% CI=-0.38 to -0.01; number needed to treat=9.43), and combination treatment was not more effective than IPT alone, although the paucity of studies precluded drawing definite conclusions. Combination maintenance treatment with pharmacotherapy and IPT was more effective in preventing relapse than pharmacotherapy alone (odds ratio=0.37; 95% CI=0.19 to 0.73; number needed to treat=7.63). Conclusions: There is no doubt that IPT efficaciously treats depression, both as an independent treatment and in combination with pharmacotherapy. IPT deserves its place in treatment guidelines as one of the most empirically validated treatments for depression.
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| 5. |
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| 6. |
- Cuijpers, Pim, et al.
(författare)
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Psychotherapy for chronic major depression and dysthymia: A meta-analysis
- 2010
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Ingår i: Clinical Psychology Review. - : Elsevier BV. - 0272-7358 .- 1873-7811. ; 30:1, s. 51-62
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Forskningsöversikt (refereegranskat)abstract
- Although several studies have examined the effects of psychotherapy on chronic depression and dysthymia, no meta-analysis has been conducted to integrate results of these studies. We conducted a meta-analysis of 16 randomized trials examining the effects of psychotherapy on chronic depression and dysthymia. We found that psychotherapy had a small but significant effect (d=0.23) on depression when compared to control groups. Psychotherapy was significantly less effective than pharmacotherapy in direct comparisons (d=-031), especially SSRIs, but that this finding was wholly attributable to dysthymic patients (the studies examining dysthymia patients were the same studies that examined SSRIs). Combined treatment was more effective than pharmacotherapy alone (d=0.23) but even more so with respect to psychotherapy alone (d=0.45), although again this difference may have reflected the greater proportion of dysthymic samples in the latter. No significant differences were found in drop-out rates between psychotherapy and the other conditions. We found indications that at least 18 treatment sessions are needed to realize optimal effects of psychotherapy. We conclude that psychotherapy is effective in the treatment of chronic depression and dysthymia but probably not as effective as pharmacotherapy (particularly the SSRIs).
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| 7. |
- Cuijpers, Pim, et al.
(författare)
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Psychotherapy for Depression in Adults : A Meta-Analysis of Comparative Outcome Studies
- 2008
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Ingår i: Journal of Consulting and Clinical Psychology. - : American Psychological Association (APA). - 0022-006X .- 1939-2117. ; 76:6, s. 909-922
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Tidskriftsartikel (refereegranskat)abstract
- Although the subject has been debated and examined for more than 3 decades, it is si ill not clear whether all psychotherapies are equally efficacious. The authors conducted 7 meta-analyses (with a total of 53 studies) in which 7 major types of psychological treatment for mild to moderate adult depression (cognitive-behavior therapy, nondirective supportive treatment, behavioral activation treatment, psychodynamic treatment. problem-solving therapy, interpersonal psychotherapy, and social skills training) were directly compared with other psychological treatments. Each major type of treatment had been examined in at least 5 randomized comparative trials. There was no indication that I of the treatments was more or less efficacious, with the exception of interpersonal psychotherapy (which was somewhat more efficacious; d = 0.20) and nondirective supportive treatment (which was somewhat less efficacious than the other treatments: d = -0.13). The drop-out rate was significantly higher in cognitive-behavior therapy than in the other therapies, whereas it was significantly lower in problem-solving therapy. This study suggests that there are no large differences in efficacy between the major psychotherapies for mild to moderate depression.
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| 8. |
- Cuijpers, Pim, et al.
(författare)
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The efficacy of non-directive supportive therapy for adult depression : A meta-analysis
- 2012
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Ingår i: Clinical Psychology Review. - : Elsevier. - 0272-7358 .- 1873-7811. ; 32:4, s. 280-291
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Tidskriftsartikel (refereegranskat)abstract
- The effects of non-directive supportive therapy (NDST) for adult depression have been examined in a considerable number of studies, but no meta-analysis of these studies has been conducted. We selected 31 studies on NDST from a comprehensive database of trials, examining psychotherapies for adult depression, and conducted meta-analyses in which NDST was compared with control groups, other psychotherapies and pharmacotherapy. We found that NDST is effective in the treatment of depression in adults (g=0.58; 95% CI: 0.45-0.72). NDST was less effective than other psychological treatments (differential effect size g=-0.20; 95% CI: -0.32 to -0.08, p<0.01), but these differences were no longer present after controlling for researcher allegiance. We estimated that extra-therapeutic factors (those processes operating in waiting-list and care-as-usual controls) were responsible for 33.3% of the overall improvement, non-specific factors (the effects of NDST compared with control groups) for 49.6%, and specific factors (the effects of NDST compared with other therapies) for 17.1%. NDST has a considerable effect on symptoms of depression. Most of the effect of therapy for adult depression is realized by non-specific factors, and our results suggest that the contribution of specific effects is limited at best.
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