The symptom-specific efficacy of antidepressant medication vs. cognitive behavioral therapy in the treatment of depression: results from an individual patient data meta-analysis

Lynn Boschloo; Ella Bekhuis; Erica S Weitz; Mirjam Reijnders; Robert J DeRubeis; Sona Dimidjian; David L Dunner; Boadie W Dunlop; Ulrich Hegerl; Steven D Hollon; Robin B Jarrett; Sidney H Kennedy; Jeanne Miranda; David C Mohr; Anne D Simons; Gordon Parker; Frank Petrak; Stephan Herpertz; Lena C Quilty; A John Rush; Zindel V Segal; Jeffrey R Vittengl; Robert A Schoevers; Pim Cuijpers

doi:10.1002/wps.20630

The symptom-specific efficacy of antidepressant medication vs. cognitive behavioral therapy in the treatment of depression: results from an individual patient data meta-analysis

World Psychiatry. 2019 Jun;18(2):183-191. doi: 10.1002/wps.20630.

Authors

Lynn Boschloo^{1

2}, Ella Bekhuis², Erica S Weitz¹, Mirjam Reijnders¹, Robert J DeRubeis³, Sona Dimidjian⁴, David L Dunner⁵, Boadie W Dunlop⁶, Ulrich Hegerl⁷, Steven D Hollon⁸, Robin B Jarrett⁹, Sidney H Kennedy¹⁰, Jeanne Miranda¹¹, David C Mohr¹², Anne D Simons¹³, Gordon Parker¹⁴, Frank Petrak¹⁵, Stephan Herpertz¹⁵, Lena C Quilty^{10

16}, A John Rush^{17

18

19}, Zindel V Segal²⁰, Jeffrey R Vittengl²¹, Robert A Schoevers², Pim Cuijpers¹

Affiliations

¹ Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
² Department of Psychiatry and Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
³ Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA.
⁴ Department of Psychology and Neuroscience, University of Colorado, Boulder, CO, USA.
⁵ Center for Anxiety and Depression, Mercer Island, Washington, WA, USA.
⁶ Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
⁷ Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany.
⁸ Department of Psychology, Vanderbilt University, Nashville, TN, USA.
⁹ Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.
¹⁰ Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
¹¹ Health Services Research Center, Neuropsychiatric Institute, University of California, Los Angeles, CA, USA.
¹² Center for Behavioral Intervention Technologies, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
¹³ Department of Psychology, University of Notre Dame, Notre Dame, IN, USA.
¹⁴ School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.
¹⁵ Department of Psychosomatic Medicine and Psychotherapy, LWL-University Clinic Bochum, Ruhr University Bochum, Bochum, Germany.
¹⁶ Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.
¹⁷ Duke-National University of Singapore Graduate Medical School, Singapore.
¹⁸ Department of Psychiatry, Duke Medical School, Durham, NC, USA.
¹⁹ Texas Tech University Health Sciences Center, Permian Basin, TX, USA.
²⁰ Department of Psychology, University of Toronto Scarborough, Toronto, ON, Canada.
²¹ Department of Psychology, Truman State University, Kirksville, MO, USA.

Abstract

A recent individual patient data meta-analysis showed that antidepressant medication is slightly more efficacious than cognitive behavioral therapy (CBT) in reducing overall depression severity in patients with a DSM-defined depressive disorder. We used an update of that dataset, based on seventeen randomized clinical trials, to examine the comparative efficacy of antidepressant medication vs. CBT in more detail by focusing on individual depressive symptoms as assessed with the 17-item Hamilton Rating Scale for Depression. Five symptoms (i.e., "depressed mood" , "feelings of guilt" , "suicidal thoughts" , "psychic anxiety" and "general somatic symptoms") showed larger improvements in the medication compared to the CBT condition (effect sizes ranging from .13 to .16), whereas no differences were found for the twelve other symptoms. In addition, network estimation techniques revealed that all effects, except that on "depressed mood" , were direct and could not be explained by any of the other direct or indirect treatment effects. Exploratory analyses showed that information about the symptom-specific efficacy could help in identifying those patients who, based on their pre-treatment symptomatology, are likely to benefit more from antidepressant medication than from CBT (effect size of .30) versus those for whom both treatments are likely to be equally efficacious. Overall, our symptom-oriented approach results in a more thorough evaluation of the efficacy of antidepressant medication over CBT and shows potential in "precision psychiatry" .

Keywords: Depression; antidepressant medication; cognitive behavioral therapy; depressed mood; depressive symptoms; feelings of guilt; general somatic symptoms; precision psychiatry; psychic anxiety; suicidal thoughts.