Certain types of psychotherapies treated adult depression more effectively and acceptably, with several having significant long-term effects after 1 year.
These types of psychotherapies included cognitive behavioral, behavioral activation, problem-solving, “third wave therapy,” interpersonal psychotherapy, psychodynamic and life-review therapy. No significant differences existed between them, according to Pim Cuijpers, PhD, professor of clinical psychology at the Vrije Universiteit Amsterdam, and colleagues.
“Patient preference and availability of each treatment type may play a larger role in the choice between types of psychotherapy, although it is possible that a more detailed characterization of patients with a diagnosis of depression may lead to a more precise matching between individual patients and individual psychotherapies,” they wrote.
To integrate study results on the effects of psychotherapies, Cuijpers and colleagues conducted network and random-effects pairwise meta-analyses on 331 randomized trials with 34,285 patients. The trials concerned cognitive behavioral, interpersonal, psychodynamic, problem-solving, behavioral activation, life-review and “third wave” therapies and non-directive supportive counseling. A 50% or greater reduction in symptoms served as the primary outcome. The researchers also assessed remission, standardized mean difference (SMD) and dropout rate.
Results showed greater efficacies for all assessed therapies than care-as-usual and waiting list control conditions. All therapies aside from non-directive supportive counseling and psychodynamic therapy had greater efficacy than pill placebo. The researchers noted a range of SMDs compared with care-as-usual of –0.81 for life-review therapy to –0.32 for non-directive supportive counseling. Further, they found no significant differences between individual psychotherapies, aside from for non-directive supportive counseling, which had less efficacy than all other therapies. Upon including only studies with low risk for bias, the results appeared similar.
At 12-month follow-up, most therapies still had significant effects compared with care-as-usual, and the researchers noted problem-solving therapy had a somewhat higher long-term efficacy than some other therapies. Cuijpers and colleagues reported no consistent differences in acceptability.
“The fact that all psychotherapies can be efficacious means that, when choosing a therapy, patient’s preferences can have a prominent role,” Cuijpers and colleagues wrote. “Mental health professionals need to facilitate access to evidence-based updated information about the effects of treatment interventions and to involve patients more in their day-to-day care, with a focus on carefully acknowledging the risk and outlining potential effects while managing expectations.”