The effects of cognitive therapy versus 'treatment as usual' in patients with major depressive disorder

Janus Christian Jakobsen, Jane Lindschou Hansen, Ole Jakob Storebø, Erik Simonsen, Christian Gluud

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

    Abstract

    Background: Major depressive disorder afflicts an estimated 17% of individuals during their lifetimes at tremendous suffering and costs. Cognitive therapy may be an effective treatment option for major depressive disorder, but the effects
    have only had limited assessment in systematic reviews.

    Methods/Principal Findings: Cochrane systematic review methodology, with meta-analyses and trial sequential analyses of randomized trials, are comparing the effects of cognitive therapy versus ‘treatment as usual’ for major depressive disorder. To be included the participants had to be older than 17 years with a primary diagnosis of major depressive disorder. Altogether, we included eight trials randomizing a total of 719 participants. All eight trials had high risk of bias. Four trials reported data on the 17-item Hamilton Rating Scale for Depression and four trials reported data on the Beck Depression Inventory. Metaanalysis on the data from the Hamilton Rating Scale for Depression showed that cognitive therapy compared with ‘treatment as usual’ significantly reduced depressive symptoms (mean difference 22.15 (95% confidence interval 23.70 to 20.60; P,0.007, no heterogeneity)). However, meta-analysis with both fixed-effect and random-effects model on the data from the Beck Depression Inventory (mean difference with both models 21.57 (95% CL 24.30 to 1.16; P = 0.26, I2 = 0) could not confirm the Hamilton Rating Scale for Depression results. Furthermore, trial sequential analysis on both the data from Hamilton Rating
    Scale for Depression and Becks Depression Inventory showed that insufficient data have been obtained.

    Discussion: Cognitive therapy might not be an effective treatment for major depressive disorder compared with ‘treatment
    as usual’. The possible treatment effect measured on the Hamilton Rating Scale for Depression is relatively small. More
    randomized trials with low risk of bias, increased sample sizes, and broader more clinically relevant outcomes are needed.
    OriginalsprogEngelsk
    TidsskriftP L o S One
    Vol/bind6
    Udgave nummer8
    Sider (fra-til)e22890
    ISSN1932-6203
    DOI
    StatusUdgivet - 2011

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