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. 2014 Feb;13(1):56-67.
doi: 10.1002/wps.20089.

Adding psychotherapy to antidepressant medication in depression and anxiety disorders: a meta-analysis

Pim Cuijpers  1 , Marit Sijbrandij, Sander L Koole, Gerhard Andersson, Aartjan T Beekman, Charles F Reynolds 3rd
Affiliations

Adding psychotherapy to antidepressant medication in depression and anxiety disorders: a meta-analysis

Pim Cuijpers et al. World Psychiatry. 2014 Feb.

Abstract

We conducted a meta-analysis of randomized trials in which the effects of treatment with antidepressant medication were compared to the effects of combined pharmacotherapy and psychotherapy in adults with a diagnosed depressive or anxiety disorder. A total of 52 studies (with 3,623 patients) met inclusion criteria, 32 on depressive disorders and 21 on anxiety disorders (one on both depressive and anxiety disorders). The overall difference between pharmacotherapy and combined treatment was Hedges' g = 0.43 (95% CI: 0.31-0.56), indicating a moderately large effect and clinically meaningful difference in favor of combined treatment, which corresponds to a number needed to treat (NNT) of 4.20. There was sufficient evidence that combined treatment is superior for major depression, panic disorder, and obsessive-compulsive disorder (OCD). The effects of combined treatment compared with placebo only were about twice as large as those of pharmacotherapy compared with placebo only, underscoring the clinical advantage of combined treatment. The results also suggest that the effects of pharmacotherapy and those of psychotherapy are largely independent from each other, with both contributing about equally to the effects of combined treatment. We conclude that combined treatment appears to be more effective than treatment with antidepressant medication alone in major depression, panic disorder, and OCD. These effects remain strong and significant up to two years after treatment. Monotherapy with psychotropic medication may not constitute optimal care for common mental disorders.

Keywords: Combined treatment; antidepressant medication; anxiety disorders; depressive disorders; dysthymia; meta-analysis; obsessive-compulsive disorder; psychotherapy.

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Figures

Figure 1
Figure 1
Selection and inclusion of studies. GAD – generalized anxiety disorder, OCD – obsessive-compulsive disorder, PTSD – post-traumatic stress disorder, SAD – social anxiety disorder
Figure 2
Figure 2
Effects of pharmacotherapy compared to combined treatment with pharmacotherapy and psychotherapy (Hedges' g)
See this image and copyright information in PMC

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