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A meta-analysis of psychotherapy and medication in unipolar depression and dysthymia.

Abstract：

BACKGROUND:There remains considerable disagreement regarding the relative efficacy of psychotherapy and medication across types of depression. METHOD:We used random effects meta-analysis to examine the relative efficacy of psychotherapy vis-à-vis medication at post-treatment and follow-up. We also estimated the relative efficacy of continued medication versus discontinued psychotherapy. As twenty-eight studies (39 effects, n=3,381) met inclusion criteria, we were able to conduct an adequately powered test of between-study heterogeneity and examine if the type of depression influenced relative efficacy. RESULTS:Psychotherapy and medication were not significantly different at post-treatment, however effect sizes were not consistent. Although there was no association between severity and relative efficacy, a small but significant advantage for medications in the treatment of dysthymia did emerge. However, psychotherapy showed a significant advantage over medication at follow-up and this advantage was positively associated with length of follow-up. Moreover, discontinued acute phase psychotherapy did not differ from continued medication at follow-up. LIMITATIONS:Limitations included relatively fewer studies of severe and chronic depression, as well as dysthymia. In addition, only a minority of studies reported follow-up data. CONCLUSIONS:Our results indicated that both psychotherapy and medication are viable treatments for unipolar depression and that psychotherapy may offer a prophylactic effect not provided by medication. However, our analyses diverged from previous findings in that effects were not consistent and medication was significantly more efficacious than psychotherapy in the treatment of dysthymia.

journal_name

J Affect Disord

journal_title

Journal of affective disorders

authors

Imel ZE,Malterer MB,McKay KM,Wampold BE

doi

10.1016/j.jad.2008.03.018

subject

Has Abstract

pub_date

2008-10-01 00:00:00

pages

197-206

issue

3

eissn

0165-0327

issn

1573-2517

pii

S0165-0327(08)00141-9

journal_volume

110

pub_type

杂志文章,meta分析

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