Zainal N. H. (2024).
Psychological medicine, 54(3), 457–472.
Abstract
Antidepressant medication (ADM)-only, psychotherapy-only, and their combination are the first-line treatment options for major depressive disorder (MDD). Previous meta-analyses of randomized controlled trials (RCTs) established that psychotherapy and combined treatment were superior to ADM-only for MDD treatment remission or response. The current meta-analysis extended previous ones by determining the comparative efficacy of ADM-only, psychotherapy-only, and combined treatment on suicide attempts and other serious psychiatric adverse events (i.e. psychiatric emergency department [ED] visit, psychiatric hospitalization, and/or suicide death; SAEs). Peto odds ratios (ORs) and their 95% confidence intervals were computed from the present random-effects meta-analysis. Thirty-four relevant RCTs were included. Psychotherapy-only was stronger than combined treatment (1.9% v. 3.7%; OR 1.96 [1.20-3.20], p = 0.012) and ADM-only (3.0% v. 5.6%; OR 0.45 [0.30-0.67], p = 0.001) in decreasing the likelihood of SAEs in the primary and trim-and-fill sensitivity analyses. Combined treatment was better than ADM-only in reducing the probability of SAEs (6.0% v. 8.7%; OR 0.74 [0.56-0.96], p = 0.029), but this comparative efficacy finding was non-significant in the sensitivity analyses. Subgroup analyses revealed the advantage of psychotherapy-only over combined treatment and ADM-only for reducing SAE risk among children and adolescents and the benefit of combined treatment over ADM-only among adults. Overall, psychotherapy and combined treatment outperformed ADM-only in reducing the likelihood of SAEs, perhaps by conferring strategies to enhance reasons for living. Plausibly, psychotherapy should be prioritized for high-risk youths and combined treatment for high-risk adults with MDD.
Here are some thoughts:
This meta-analysis examines the comparative efficacy of antidepressant medication (ADM), psychotherapy, and combined treatment in preventing suicide attempts and other serious psychiatric adverse events (SAEs) among patients with major depressive disorder (MDD). The study found that psychotherapy-only was more effective than both combined treatment and ADM-only in reducing the likelihood of SAEs. Combined treatment showed better outcomes than ADM-only in reducing SAE probability, though this finding was not significant in sensitivity analyses.
Age-specific effects were observed, with psychotherapy-only outperforming both combined treatment and ADM-only in reducing SAE risk for children and adolescents, while combined treatment was more beneficial than ADM-only for adults. These findings suggest that psychotherapy should be prioritized for high-risk youth with MDD, while combined treatment may be more beneficial for high-risk adults.
The study reinforces the importance of psychotherapy in MDD treatment, particularly for reducing serious adverse events. It also indicates that ADM-only may be less effective in preventing SAEs compared to treatments that include psychotherapy. These findings provide valuable insights for tailoring treatment approaches for MDD patients, emphasizing the critical role of psychotherapy in preventing serious adverse events and potentially saving lives.
