title: The efficacy of psychotherapy, pharmacotherapy and their combination on functioning and quality of life in depression: a meta-analysis.
abstract: BACKGROUND
  There is growing recognition of the importance of both functioning and quality of life (QoL) outcomes in the treatment of depressive disorders, but the meta-analytic evidence is scarce. The objective of this meta-analysis of randomized controlled trials (RCTs) was to determine the absolute and relative effects of psychotherapy, pharmacotherapy and their combination on functioning and QoL in patients with depression.
  
  
  METHODS
  One hundred and fifty-three outcome trials involving 29 879 participants with depressive disorders were identified through database searches in Pubmed, PsycINFO and the Cochrane Central Register of Controlled Trials.
  
  
  RESULTS
  Compared to control conditions, psychotherapy and pharmacotherapy yielded small to moderate effect sizes for functioning and QoL, ranging from g = 0.31 to g = 0.43. When compared directly, initial analysis yielded no evidence that one of them was superior. After adjusting for publication bias, psychotherapy was more efficacious than pharmacotherapy (g = 0.21) for QoL. The combination of psychotherapy and medication performed significantly better for both outcomes compared to each treatment alone yielding small effect sizes (g = 0.32 to g = 0.39). Both interventions improved depression symptom severity more than functioning and QoL.
  
  
  CONCLUSIONS
  Despite the small number of comparative trials for some of the analyses, this study reveals that combined treatment is superior, but psychotherapy and pharmacotherapy alone are also efficacious for improving functioning and QoL. The overall relatively modest effects suggest that future tailoring of therapies could be warranted to better meet the needs of individuals with functioning and QoL problems.
authors: Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red, CIBERSAM,Madrid,Spain.
authors: K
authors: K
authors: Kamenov
authors: Faculty of Social and Human Sciences,University of Southampton,Southampton,UK.
authors: C
authors: C
authors: Twomey
authors: Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red, CIBERSAM,Madrid,Spain.
authors: M
authors: M
authors: Cabello
authors: Health Service and Population Research Department,Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London,London,UK.
authors: A M
authors: AM
authors: Prina
authors: Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red, CIBERSAM,Madrid,Spain.
authors: J L
authors: JL
authors: Ayuso-Mateos
mesh_terms: D000928:Antidepressive Agents / Q000494:pharmacology*; D003131:Combined Modality Therapy; D003866:Depressive Disorder / Q000188:drug therapy / Q000628:therapy*; D006801:Humans; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D011613:Psychotherapy / Q000706:statistics & numerical data*; D011788:Quality of Life
chemical_list: D000928:Antidepressive Agents
keywords: Depression; functioning; meta-analysis; pharmacotherapy; psychotherapy; quality of life