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

    Resumé

    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

    Citer dette

    Jakobsen, Janus Christian ; Hansen, Jane Lindschou ; Storebø, Ole Jakob ; Simonsen, Erik ; Gluud, Christian. / The effects of cognitive therapy versus 'treatment as usual' in patients with major depressive disorder. I: P L o S One. 2011 ; Bind 6, Nr. 8. s. e22890.
    @article{5624f6201f7c478f8f0636034ef32687,
    title = "The effects of cognitive therapy versus 'treatment as usual' in patients with major depressive disorder",
    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 effectshave 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 RatingScale 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 ‘treatmentas usual’. The possible treatment effect measured on the Hamilton Rating Scale for Depression is relatively small. Morerandomized trials with low risk of bias, increased sample sizes, and broader more clinically relevant outcomes are needed.",
    author = "Jakobsen, {Janus Christian} and Hansen, {Jane Lindschou} and Storeb{\o}, {Ole Jakob} and Erik Simonsen and Christian Gluud",
    year = "2011",
    doi = "10.1371/journal.pone.0022890",
    language = "English",
    volume = "6",
    pages = "e22890",
    journal = "P L o S One",
    issn = "1932-6203",
    publisher = "Public Library of Science",
    number = "8",

    }

    The effects of cognitive therapy versus 'treatment as usual' in patients with major depressive disorder. / Jakobsen, Janus Christian; Hansen, Jane Lindschou; Storebø, Ole Jakob; Simonsen, Erik; Gluud, Christian.

    I: P L o S One, Bind 6, Nr. 8, 2011, s. e22890.

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

    TY - JOUR

    T1 - The effects of cognitive therapy versus 'treatment as usual' in patients with major depressive disorder

    AU - Jakobsen, Janus Christian

    AU - Hansen, Jane Lindschou

    AU - Storebø, Ole Jakob

    AU - Simonsen, Erik

    AU - Gluud, Christian

    PY - 2011

    Y1 - 2011

    N2 - 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 effectshave 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 RatingScale 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 ‘treatmentas usual’. The possible treatment effect measured on the Hamilton Rating Scale for Depression is relatively small. Morerandomized trials with low risk of bias, increased sample sizes, and broader more clinically relevant outcomes are needed.

    AB - 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 effectshave 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 RatingScale 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 ‘treatmentas usual’. The possible treatment effect measured on the Hamilton Rating Scale for Depression is relatively small. Morerandomized trials with low risk of bias, increased sample sizes, and broader more clinically relevant outcomes are needed.

    U2 - 10.1371/journal.pone.0022890

    DO - 10.1371/journal.pone.0022890

    M3 - Journal article

    VL - 6

    SP - e22890

    JO - P L o S One

    JF - P L o S One

    SN - 1932-6203

    IS - 8

    ER -