Effectiveness of therapy for depression
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Effectiveness of Therapy for Depression
Psychotherapy for Depression: General Effectiveness
Psychotherapy has been shown to be effective in treating depression, although the degree of effectiveness can vary. A re-analysis of Cuijpers et al.'s meta-analysis found that psychotherapy had a standardized mean difference (SMD) of approximately 0.70 when compared to wait-list controls, indicating a moderate effect size. This suggests that psychotherapy is more effective than no treatment and care-as-usual, with SMDs of 0.31 and 0.43, respectively.
Cognitive Behavioral Therapy (CBT): Delivery Formats and Effectiveness
Cognitive Behavioral Therapy (CBT) is one of the most extensively studied psychotherapies for depression. A network meta-analysis comparing different delivery formats of CBT found that individual, group, telephone, and guided self-help CBT were all significantly more effective than wait-list and care-as-usual controls, with SMDs ranging from 0.47 to 1.02. However, unguided self-help CBT was less effective, with SMDs between 0.34 and 0.59. In terms of acceptability, individual and group CBT had lower dropout rates compared to guided self-help CBT.
Comparative Efficacy of CBT
A comprehensive meta-analysis including 409 trials with 52,702 patients found that CBT had moderate to large effects compared to control conditions (g=0.79) and was more effective than other psychotherapies, although the difference was small and often non-significant in sensitivity analyses. CBT was as effective as pharmacotherapies in the short term but showed greater efficacy at 6-12 month follow-up (g=0.34). Combined treatment (CBT plus pharmacotherapy) was more effective than pharmacotherapy alone but not more effective than CBT alone.
Group Support Psychotherapy (GSP) for Depression in Low-Income Settings
Group Support Psychotherapy (GSP) delivered by lay health workers has been shown to be effective in treating depression among people living with HIV in Uganda. A cluster-randomized trial found that only 0.3% of participants in the GSP group had major depression six months post-treatment compared to 28% in the control group. GSP was also found to be cost-effective, with an incremental cost-effectiveness ratio of $13.70 per disability-adjusted life-year averted.
Psychotherapy for Treatment-Resistant Depression (TRD)
For patients with treatment-resistant depression (TRD), psychotherapy can still offer benefits. A meta-analysis found that add-on psychotherapy to treatment-as-usual (TAU) had a moderate effect size (0.42) compared to TAU alone. This suggests that psychotherapy can be a valuable addition to existing treatment regimens for TRD.
Short-Term Psychodynamic Psychotherapy (STPP)
Short-term psychodynamic psychotherapy (STPP) has also been found to be effective for depression. A meta-analysis of 54 studies found that STPP was significantly more effective than control conditions at post-treatment, with effect sizes ranging from 0.49 to 0.69. STPP showed significant improvements in depression, general psychopathology, and quality of life, which were maintained or further improved at follow-up.
Internet-Based Cognitive Behavioral Therapy (iCBT)
Internet-based CBT (iCBT) offers a flexible and accessible treatment option. A systematic review and individual patient data network meta-analysis found that both guided and unguided iCBT were effective in reducing depression symptoms in the short and long term. Guided iCBT was more effective than unguided iCBT, particularly for individuals with moderate to severe depression.
Conclusion
Overall, various forms of psychotherapy, including CBT, GSP, STPP, and iCBT, have been shown to be effective in treating depression. The effectiveness can vary based on the delivery format, patient characteristics, and whether the therapy is combined with other treatments. Psychotherapy remains a valuable and effective option for managing depression across different settings and patient populations.
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