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Quantified superiority of cognitive behaviour therapy to antidepressant drugs: a challenge to an earlier meta-analysis


Gordon B. Parker, Black Dog Institute, Hospital Road, Prince of Wales Hospital, High Street, Randwick NSW 2031, Sydney, Australia.


Objective:  The study aimed to review the conclusion of a previously published meta-analysis which quantified distinct superiority of cognitive therapy to antidepressant drug-therapy (P < 0.0001).

Method:  We sought to include all studies used in the original meta-analysis. Adopting both that study’s inclusion criteria and additional criteria resulted in a reduced set of studies. We analysed both ‘completer’ and ‘intention to treat’ data, using effect size and odds ratio quantification.

Results:  There was an overall trend for cognitive therapy to be superior to antidepressant drug-therapy, but this was significant for only one of the four meta-analyses (an intention to treat analysis). We demonstrated considerable heterogeneity between studies, and a significantly higher drop-out rate in the antidepressant groups.

Conclusion:  The previous interpretation – cognitive therapy being distinctly superior to antidepressant medication – cannot be sustained from the currently analysed data set.