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Meta-Analysis
. 2017 Feb;47(3):414-425.
doi: 10.1017/S0033291716002774. Epub 2016 Oct 26.

The efficacy of psychotherapy, pharmacotherapy and their combination on functioning and quality of life in depression: a meta-analysis

K Kamenov  1 , C Twomey  2 , M Cabello  1 , A M Prina  3 , J L Ayuso-Mateos  1
Affiliations
Meta-Analysis

The efficacy of psychotherapy, pharmacotherapy and their combination on functioning and quality of life in depression: a meta-analysis

K Kamenov et al. Psychol Med. 2017 Feb.

Abstract

Background: There is growing recognition of the importance of both functioning and quality of life (QoL) outcomes in the treatment of depressive disorders, but the meta-analytic evidence is scarce. The objective of this meta-analysis of randomized controlled trials (RCTs) was to determine the absolute and relative effects of psychotherapy, pharmacotherapy and their combination on functioning and QoL in patients with depression.

Method: One hundred and fifty-three outcome trials involving 29 879 participants with depressive disorders were identified through database searches in Pubmed, PsycINFO and the Cochrane Central Register of Controlled Trials.

Results: Compared to control conditions, psychotherapy and pharmacotherapy yielded small to moderate effect sizes for functioning and QoL, ranging from g = 0.31 to g = 0.43. When compared directly, initial analysis yielded no evidence that one of them was superior. After adjusting for publication bias, psychotherapy was more efficacious than pharmacotherapy (g = 0.21) for QoL. The combination of psychotherapy and medication performed significantly better for both outcomes compared to each treatment alone yielding small effect sizes (g = 0.32 to g = 0.39). Both interventions improved depression symptom severity more than functioning and QoL.

Conclusion: Despite the small number of comparative trials for some of the analyses, this study reveals that combined treatment is superior, but psychotherapy and pharmacotherapy alone are also efficacious for improving functioning and QoL. The overall relatively modest effects suggest that future tailoring of therapies could be warranted to better meet the needs of individuals with functioning and QoL problems.

Keywords: Depression; functioning; meta-analysis; pharmacotherapy; psychotherapy; quality of life.

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Figures

Fig. 1.
Fig. 1.
Flow chart of study selection.
Fig. 2.
Fig. 2.
Total standardized effect sizes (Hedges' g) of psychotherapy and pharmacotherapy against control condition for functioning and QoL.
Fig. 3.
Fig. 3.
Standardized effect sizes (Hedges' g) of psychotherapy against pharmacotherapy on functioning and QoL.
Fig. 4.
Fig. 4.
Standardized effect sizes (Hedges' g) of combined treatment against psychotherapy and medication alone on functioning and QoL.
See this image and copyright information in PMC

References

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    1. APA (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th edn, Text Revision (DSM-IV-TR). American Psychiatric Association: Washington, DC.
    1. Bosmans JE, van Schaik DJ, de Bruijne MC, van Hout HP, van Marwijk HW, van Tulder MW, Stalman WA (2008). Are psychological treatments for depression in primary care cost-effective? Journal of Mental Health Policy and Economics 11, 3–15. - PubMed
    1. Cohen J (1988). Statistical Power Analysis for the Behavioral Sciences, 2nd edn. Erlbaum: Hillsdale, NJ.

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