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JAMA Psychiatry. 2015 Nov;72(11):1102-9. doi: 10.1001/jamapsychiatry.2015.1516.

Baseline Depression Severity as Moderator of Depression Outcomes Between Cognitive Behavioral Therapy vs Pharmacotherapy: An Individual Patient Data Meta-analysis.

Author information

1
Department of Clinical Psychology and EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, the Netherlands.
2
Department of Psychology, Vanderbilt University, Nashville, Tennessee.
3
Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, the Netherlands.
4
Department of Clinical Psychology and Psychotherapy, Babes-Bolyai University, Cluj, Romania.
5
Department of Psychology, University of Pennsylvania, Philadelphia.
6
Department of Psychology and Neuroscience, University of Colorado, Boulder.
7
Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia.
8
Fatemeh Zahra Infertility and Reproductive Health Research Center, Babol University of Medical Sciences, Babol, Iran.
9
Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany.
10
Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas.
11
Department of Psychiatry, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran.
12
Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
13
Health Services Research Center, Neuropsychiatric Institute, University of California, Los Angeles.
14
Center for Behavioral Intervention Technologies, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
15
Duke-National University of Singapore Graduate Medical School, Singapore.
16
Department of Psychology, University of Toronto Scarborough, Toronto, Ontario, Canada.
17
Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
18
Department of Psychology, University of Notre Dame, Notre Dame, Indiana.
19
Department of Psychology, Truman State University, Kirksville, Missouri.

Abstract

IMPORTANCE:

Current guidelines recommend treating severe depression with pharmacotherapy. Randomized clinical trials as well as traditional meta-analyses have considerable limitations in testing for moderators of treatment outcomes.

OBJECTIVES:

To conduct a systematic literature search, collect primary data from trials, and analyze baseline depression severity as a moderator of treatment outcomes between cognitive behavioral therapy (CBT) and antidepressant medication (ADM).

DATA SOURCES:

A total of 14 902 abstracts were examined from a comprehensive literature search in PubMed, PsycINFO, EMBASE, and Cochrane Registry of Controlled Trials from 1966 to January 1, 2014.

STUDY SELECTION:

Randomized clinical trials in which CBT and ADM were compared in patients with a DSM-defined depressive disorder were included.

DATA EXTRACTION AND SYNTHESIS:

Study authors were asked to provide primary data from their trial. Primary data from 16 of 24 identified trials (67%), with 1700 outpatients (794 from the CBT condition and 906 from the ADM condition), were included. Missing data were imputed with multiple imputation methods. Mixed-effects models adjusting for study-level differences were used to examine baseline depression severity as a moderator of treatment outcomes.

MAIN OUTCOMES AND MEASURES:

Seventeen-item Hamilton Rating Scale for Depression (HAM-D) and Beck Depression Inventory (BDI).

RESULTS:

There was a main effect of ADM over CBT on the HAM-D (β = -0.88; P = .03) and a nonsignificant trend on the BDI (β = -1.14; P = .08, statistical test for trend), but no significant differences in response (odds ratio [OR], 1.24; P = .12) or remission (OR, 1.18; P = .22). Mixed-effects models using the HAM-D indicated that baseline depression severity does not moderate reductions in depressive symptoms between CBT and ADM at outcome (β = 0.00; P = .96). Similar results were seen using the BDI. Baseline depression severity also did not moderate the likelihood of response (OR, 0.99; P = .77) or remission (OR, 1.00; P = .93) between CBT and ADM.

CONCLUSIONS AND RELEVANCE:

Baseline depression severity did not moderate differences between CBT and ADM on the HAM-D or BDI or in response or remission. This finding cannot be extrapolated to other psychotherapies, to individual ADMs, or to inpatients. However, it offers new and substantial evidence that is of relevance to researchers, physicians and therapists, and patients.

[Indexed for MEDLINE]

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