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Effectiveness of psychotherapy for treatment-resistant depression: a meta-analysis and meta-regression

Published online by Cambridge University Press:  24 August 2018

Suzanne van Bronswijk ,
Neha Moopen ,
Lian Beijers ,
Henricus G. Ruhe  and
Frenk Peeters
Suzanne van Bronswijk
Affiliation:
Department of Psychiatry and Psychology, University Hospital Maastricht, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
Neha Moopen
Affiliation:
School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
Lian Beijers
Affiliation:
Department of Psychiatry, University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), Groningen, The Netherlands
Henricus G. Ruhe
Affiliation:
Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK Department of Psychiatry, Radboudumc Nijmegen, The Netherlands
Frenk Peeters*
Affiliation:
Department of Psychiatry and Psychology, University Hospital Maastricht, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
*
Author for correspondence: Frenk Peeters, E-mail: f.peeters@maastrichtuniversity.nl
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Abstract

Despite substantial advances in treatment and management strategies for major depression, less than 50% of patients respond to first-line antidepressant treatment or psychotherapy. Given the growing number of controlled studies of psychotherapy for treatment-resistant depression (TRD) and the preference for psychotherapy of depressed subjects as a treatment option, we conducted a meta-analysis and meta-regression analysis to investigate the effectiveness of psychotherapy for TRD. Seven different psychotherapies were studied in 21 trials that included a total of 25 comparisons. In three comparisons of psychotherapy v. treatment as usual (TAU) we found no evidence to conclude that there is a significant benefit of psychotherapy as compared with TAU. In 22 comparisons of add-on psychotherapy plus TAU v. TAU only, we found a moderate general effect size of 0.42 (95% CI 0.29–0.54) in favor of psychotherapy plus TAU. The meta-regression provided evidence for a positive association between baseline severity as well as group v. individual therapy format with the treatment effect. There was no evidence for publication bias. Most frequent investigated treatments were cognitive behavior therapy, interpersonal psychotherapy, mindfulness-based cognitive therapy, and cognitive behavioral analysis system of psychotherapy. Our meta-analysis provides evidence that, in addition to pharmacological and neurostimulatory treatments, the inclusion of add-on of psychotherapy to TAU in guidelines for the treatment of TRD is justified and will provide better outcomes for this difficult-to-treat population.

Keywords

Meta-analysismeta-regressionpsychotherapytreatment resistant depression
Type
Review Article
Information
Psychological Medicine , Volume 49 , Issue 3 , February 2019 , pp. 366 - 379
Copyright
Copyright © Cambridge University Press 2018 

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Footnotes

*

These authors share last authorship.

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