Efficacy of pharmacotherapy and psychotherapy for adult psychiatric disorders: a systematic overview of meta-analyses.
OBJECTIVE
There is debate about the effectiveness of psychiatric treatments and whether pharmacotherapy or psychotherapy should be primarily used.


OBJECTIVE
To perform a systematic overview on the efficacy of pharmacotherapies and psychotherapies for major psychiatric disorders and to compare the quality of pharmacotherapy and psychotherapy trials.


METHODS
We searched MEDLINE, EMBASE, PsycINFO, and the Cochrane Library (April 2012, with no time or language limit) for systematic reviews on pharmacotherapy or psychotherapy vs placebo, pharmacotherapy vs psychotherapy, and their combination vs either modality alone. Two reviewers independently selected the meta-analyses and extracted efficacy effect sizes. We assessed the quality of the individual trials included in the pharmacotherapy and psychotherapy meta-analyses with the Cochrane risk of bias tool.


RESULTS
The search yielded 45,233 results. We included 61 meta-analyses on 21 psychiatric disorders, which contained 852 individual trials and 137,126 participants. The mean effect size of the meta-analyses was medium (mean, 0.50; 95% CI, 0.41-0.59). Effect sizes of psychotherapies vs placebo tended to be higher than those of medication, but direct comparisons, albeit usually based on few trials, did not reveal consistent differences. Individual pharmacotherapy trials were more likely to have large sample sizes, blinding, control groups, and intention-to-treat analyses. In contrast, psychotherapy trials had lower dropout rates and provided follow-up data. In psychotherapy studies, wait-list designs showed larger effects than did comparisons with placebo.


CONCLUSIONS
Many pharmacotherapies and psychotherapies are effective, but there is a lot of room for improvement. Because of the multiple differences in the methods used in pharmacotherapy and psychotherapy trials, indirect comparisons of their effect sizes compared with placebo or no treatment are problematic. Well-designed direct comparisons, which are scarce, need public funding. Because patients often benefit from both forms of therapy, research should also focus on how both modalities can be best combined to maximize synergy rather than debate the use of one treatment over the other.
Department of Psychiatry and Psychotherapy, Technische Universität München, München, Germany.
Maximilian
M
Huhn
Department of Psychiatry and Psychotherapy, Technische Universität München, München, Germany.
Magdolna
M
Tardy
Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, University Campus, Ioannina, Greece.
Loukia Maria
LM
Spineli
Department of Psychiatry and Psychotherapy, Technische Universität München, München, Germany.
Werner
W
Kissling
Department of Psychiatry and Psychotherapy, Technische Universität München, München, Germany.
Hans
H
Förstl
Department of Psychiatry and Psychotherapy, Technische Universität München, München, Germany.
Gabriele
G
Pitschel-Walz
Department of Psychiatry and Psychotherapy, Technische Universität München, München, Germany2Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, England.
Claudia
C
Leucht
Department of Psychiatry and Psychotherapy, Technische Universität München, München, Germany.
Myrto
M
Samara
Department of Psychiatry and Psychotherapy, Technische Universität München, München, Germany.
Markus
M
Dold
Psychiatric Institute, University of Illinois at Chicago.
John M
JM
Davis
Department of Psychiatry and Psychotherapy, Technische Universität München, München, Germany2Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, England5Institute of Psychiatry, King's College London, London, England.
Stefan
S
Leucht
D000328:Adult; D003131:Combined Modality Therapy; D018849:Controlled Clinical Trials as Topic; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy* / Q000523:psychology / Q000628:therapy*; D011613:Psychotherapy