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Does cognitive behaviour therapy have an enduring effect that is superior to keeping patients on continuation pharmacotherapy? A meta-analysis
  1. Pim Cuijpers1,2,
  2. Steven D Hollon3,
  3. Annemieke van Straten1,2,
  4. Claudi Bockting4,
  5. Matthias Berking5,
  6. Gerhard Andersson6,7
  1. 1Department of Clinical Psychology, VU University Amsterdam, Amsterdam, The Netherlands
  2. 2EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
  3. 3Vanderbilt University, Nashville, Tennessee, USA
  4. 4Department of Clinical Psychology, Faculty of Social and Behavioral Sciences, University of Groningen, Groningen, The Netherlands
  5. 5Department of Clinical Psychology, Philipps-University Marburg, Germany
  6. 6Department of Behavioural Sciences and Learning, Swedish Institute for Disability Research, Linköping University, Linköping, Sweden
  7. 7Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institutet, Stockholm, Sweden
  1. Correspondence to Professor Pim Cuijpers; p.cuijpers{at}vu.nl

Abstract

Objectives Although cognitive behaviour therapy (CBT) and pharmacotherapy are equally effective in the acute treatment of adult depression, it is not known how they compare across the longer term. In this meta-analysis, we compared the effects of acute phase CBT without any subsequent treatment with the effects of pharmacotherapy that either were continued or discontinued across 6–18 months of follow-up.

Design We conducted systematic searches in bibliographical databases to identify relevant studies, and conducted a meta-analysis of studies meeting inclusion criteria.

Setting Mental healthcare.

Participants Patients with depressive disorders.

Interventions CBT and pharmacotherapy for depression.

Outcome measures Relapse rates at long-term follow-up.

Results 9 studies with 506 patients were included. The quality was relatively high. Short-term outcomes of CBT and pharmacotherapy were comparable, although drop out from treatment was significantly lower in CBT. Acute phase CBT was compared with pharmacotherapy discontinuation during follow-up in eight studies. Patients who received acute phase CBT were significantly less likely to relapse than patients who were withdrawn from pharmacotherapy (OR=2.61, 95% CI 1.58 to 4.31, p<0.001; numbers-needed-to-be-treated, NNT=5). The acute phase CBT was compared with continued pharmacotherapy at follow-up in five studies. There was no significant difference between acute phase CBT and continued pharmacotherapy, although there was a trend (p<0.1) indicating that patients who received acute phase CBT may be less likely to relapse following acute treatment termination than patients who were continued on pharmacotherapy (OR=1.62, 95% CI 0.97 to 2.72; NNT=10).

Conclusions We found that CBT has an enduring effect following termination of the acute treatment. We found no significant difference in relapse after the acute phase CBT versus continuation of pharmacotherapy after remission. Given the small number of studies, this finding should be interpreted with caution pending replication.

  • Mental Health

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