title: Baseline Depression Severity as Moderator of Depression Outcomes Between Cognitive Behavioral Therapy vs Pharmacotherapy: An Individual Patient Data Meta-analysis.
abstract: OBJECTIVE
  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.
  
  
  OBJECTIVE
  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).
  
  
  METHODS
  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.
  
  
  METHODS
  Randomized clinical trials in which CBT and ADM were compared in patients with a DSM-defined depressive disorder were included.
  
  
  METHODS
  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.
  
  
  METHODS
  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
  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.
authors.affiliation: Department of Clinical Psychology and EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, the Netherlands.
authors.forename: Erica S
authors.initials: ES
authors.lastname: Weitz
authors.affiliation: Department of Psychology, Vanderbilt University, Nashville, Tennessee.
authors.forename: Steven D
authors.initials: SD
authors.lastname: Hollon
authors.affiliation: Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, the Netherlands.
authors.forename: Jos
authors.initials: J
authors.lastname: Twisk
authors.affiliation: Department of Clinical Psychology and EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, the Netherlands.
authors.forename: Annemieke
authors.initials: A
authors.lastname: van Straten
authors.affiliation: Department of Clinical Psychology and EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, the Netherlands.
authors.forename: Marcus J H
authors.initials: MJ
authors.lastname: Huibers
authors.affiliation: Department of Clinical Psychology and Psychotherapy, Babes-Bolyai University, Cluj, Romania.
authors.forename: Daniel
authors.initials: D
authors.lastname: David
authors.affiliation: Department of Psychology, University of Pennsylvania, Philadelphia.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: DeRubeis
authors.affiliation: Department of Psychology and Neuroscience, University of Colorado, Boulder.
authors.forename: Sona
authors.initials: S
authors.lastname: Dimidjian
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Boadie W
authors.initials: BW
authors.lastname: Dunlop
authors.affiliation: Department of Clinical Psychology and Psychotherapy, Babes-Bolyai University, Cluj, Romania.
authors.forename: Ioana A
authors.initials: IA
authors.lastname: Cristea
authors.affiliation: Fatemeh Zahra Infertility and Reproductive Health Research Center, Babol University of Medical Sciences, Babol, Iran.
authors.forename: Mahbobeh
authors.initials: M
authors.lastname: Faramarzi
authors.affiliation: Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Hegerl
authors.affiliation: Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas.
authors.forename: Robin B
authors.initials: RB
authors.lastname: Jarrett
authors.affiliation: Department of Psychiatry, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran.
authors.forename: Farzan
authors.initials: F
authors.lastname: Kheirkhah
authors.affiliation: Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Sidney H
authors.initials: SH
authors.lastname: Kennedy
authors.affiliation: Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany.
authors.forename: Roland
authors.initials: R
authors.lastname: Mergl
authors.affiliation: Health Services Research Center, Neuropsychiatric Institute, University of California, Los Angeles.
authors.forename: Jeanne
authors.initials: J
authors.lastname: Miranda
authors.affiliation: Center for Behavioral Intervention Technologies, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: David C
authors.initials: DC
authors.lastname: Mohr
authors.affiliation: Duke-National University of Singapore Graduate Medical School, Singapore.
authors.forename: A John
authors.initials: AJ
authors.lastname: Rush
authors.affiliation: Department of Psychology, University of Toronto Scarborough, Toronto, Ontario, Canada.
authors.forename: Zindel V
authors.initials: ZV
authors.lastname: Segal
authors.affiliation: Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Juned
authors.initials: J
authors.lastname: Siddique
authors.affiliation: Department of Psychology, University of Notre Dame, Notre Dame, Indiana.
authors.forename: Anne D
authors.initials: AD
authors.lastname: Simons
authors.affiliation: Department of Psychology, Truman State University, Kirksville, Missouri.
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Vittengl
authors.affiliation: Department of Clinical Psychology and EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, the Netherlands.
authors.forename: Pim
authors.initials: P
authors.lastname: Cuijpers
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003866:Depressive Disorder / Q000188:drug therapy / Q000628:therapy*; D006801:Humans; D063868:Patient Outcome Assessment; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data*; D012720:Severity of Illness Index
chemical_list: D000928:Antidepressive Agents