The efficacy of psychotherapy and pharmacotherapy in treating depressive and anxiety disorders: a meta-analysis of direct comparisons

Authors

  • Pim Cuijpers,

    1. Department of Clinical Psychology, VU University Amsterdam, BT Amsterdam, The Netherlands
    2. EMGO Institute for Health and Care Research, VU University and VU University Medical Center, Amsterdam, The Netherlands
    3. Leuphana University, Lünebrug, Germany
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  • Marit Sijbrandij,

    1. Department of Clinical Psychology, VU University Amsterdam, BT Amsterdam, The Netherlands
    2. EMGO Institute for Health and Care Research, VU University and VU University Medical Center, Amsterdam, The Netherlands
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  • Sander L. Koole,

    1. Department of Clinical Psychology, VU University Amsterdam, BT Amsterdam, The Netherlands
    2. EMGO Institute for Health and Care Research, VU University and VU University Medical Center, Amsterdam, The Netherlands
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  • Gerhard Andersson,

    1. Department of Behavioural Sciences and Learning, Swedish Institute for Disability Research, University of Linköping, Sweden
    2. Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institutet, Stockholm, Sweden
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  • Aartjan T. Beekman,

    1. EMGO Institute for Health and Care Research, VU University and VU University Medical Center, Amsterdam, The Netherlands
    2. Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
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  • Charles F. Reynolds III

    1. Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Abstract

Although psychotherapy and antidepressant medication are efficacious in the treatment of depressive and anxiety disorders, it is not known whether they are equally efficacious for all types of disorders, and whether all types of psychotherapy and antidepressants are equally efficacious for each disorder. We conducted a meta-analysis of studies in which psychotherapy and antidepressant medication were directly compared in the treatment of depressive and anxiety disorders. Systematic searches in bibliographical databases resulted in 67 randomized trials, including 5,993 patients that met inclusion criteria, 40 studies focusing on depressive disorders and 27 focusing on anxiety disorders. The overall effect size indicating the difference between psychotherapy and pharmacotherapy after treatment in all disorders was g=0.02 (95% CI: −0.07 to 0.10), which was not statistically significant. Pharmacotherapy was significantly more efficacious than psychotherapy in dysthymia (g=0.30), and psychotherapy was significantly more efficacious than pharmacotherapy in obsessive-compulsive disorder (g=0.64). Furthermore, pharmacotherapy was significantly more efficacious than non-directive counseling (g=0.33), and psychotherapy was significantly more efficacious than pharmacotherapy with tricyclic antidepressants (g=0.21). These results remained significant when we controlled for other characteristics of the studies in multivariate meta-regression analysis, except for the differential effects in dysthymia, which were no longer statistically significant.

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