The efficacy of psychotherapy and pharmacotherapy in treating depressive and anxiety disorders: a meta‐analysis of direct comparisons

TLDR

Psychotherapy and antidepressant medication are both effective for depressive and anxiety disorders, but it is unclear whether they are equally efficacious across all disorder types and treatment modalities. The study performed a meta‑analysis directly comparing psychotherapy and antidepressant medication for depressive and anxiety disorders. The authors identified 67 randomized trials (5,993 patients) through systematic database searches, including 40 studies on depressive disorders and 27 on anxiety disorders. Overall, psychotherapy and pharmacotherapy produced equivalent outcomes (g = 0.02, 95 % CI −0.07 to 0.10); however, pharmacotherapy outperformed psychotherapy in dysthymia, while psychotherapy outperformed pharmacotherapy in obsessive‑compulsive disorder, and similar differential effects were observed against non‑directive counseling and tricyclic antidepressants, with most differences remaining significant after multivariate adjustment.

Abstract

Although psychotherapy and antidepressant medication are efficacious in the treatment of depressive and anxiety disorders, it is not known whether they are equally efficacious for all types of disorders, and whether all types of psychotherapy and antidepressants are equally efficacious for each disorder. We conducted a meta-analysis of studies in which psychotherapy and antidepressant medication were directly compared in the treatment of depressive and anxiety disorders. Systematic searches in bibliographical databases resulted in 67 randomized trials, including 5,993 patients that met inclusion criteria, 40 studies focusing on depressive disorders and 27 focusing on anxiety disorders. The overall effect size indicating the difference between psychotherapy and pharmacotherapy after treatment in all disorders was g=0.02 (95% CI: -0.07 to 0.10), which was not statistically significant. Pharmacotherapy was significantly more efficacious than psychotherapy in dysthymia (g=0.30), and psychotherapy was significantly more efficacious than pharmacotherapy in obsessive-compulsive disorder (g=0.64). Furthermore, pharmacotherapy was significantly more efficacious than non-directive counseling (g=0.33), and psychotherapy was significantly more efficacious than pharmacotherapy with tricyclic antidepressants (g=0.21). These results remained significant when we controlled for other characteristics of the studies in multivariate meta-regression analysis, except for the differential effects in dysthymia, which were no longer statistically significant.