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Effectiveness of psychotherapy for treatment-resistant depression: a meta-analysis and meta-regression

Published online by Cambridge University Press:  24 August 2018

Suzanne van Bronswijk ,
Neha Moopen ,
Lian Beijers ,
Henricus G. Ruhe  and
Frenk Peeters
Suzanne van Bronswijk
Affiliation:
Department of Psychiatry and Psychology, University Hospital Maastricht, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
Neha Moopen
Affiliation:
School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
Lian Beijers
Affiliation:
Department of Psychiatry, University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), Groningen, The Netherlands
Henricus G. Ruhe
Affiliation:
Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK Department of Psychiatry, Radboudumc Nijmegen, The Netherlands
Frenk Peeters*
Affiliation:
Department of Psychiatry and Psychology, University Hospital Maastricht, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
*
Author for correspondence: Frenk Peeters, E-mail: [email protected]
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Abstract

Despite substantial advances in treatment and management strategies for major depression, less than 50% of patients respond to first-line antidepressant treatment or psychotherapy. Given the growing number of controlled studies of psychotherapy for treatment-resistant depression (TRD) and the preference for psychotherapy of depressed subjects as a treatment option, we conducted a meta-analysis and meta-regression analysis to investigate the effectiveness of psychotherapy for TRD. Seven different psychotherapies were studied in 21 trials that included a total of 25 comparisons. In three comparisons of psychotherapy v. treatment as usual (TAU) we found no evidence to conclude that there is a significant benefit of psychotherapy as compared with TAU. In 22 comparisons of add-on psychotherapy plus TAU v. TAU only, we found a moderate general effect size of 0.42 (95% CI 0.29–0.54) in favor of psychotherapy plus TAU. The meta-regression provided evidence for a positive association between baseline severity as well as group v. individual therapy format with the treatment effect. There was no evidence for publication bias. Most frequent investigated treatments were cognitive behavior therapy, interpersonal psychotherapy, mindfulness-based cognitive therapy, and cognitive behavioral analysis system of psychotherapy. Our meta-analysis provides evidence that, in addition to pharmacological and neurostimulatory treatments, the inclusion of add-on of psychotherapy to TAU in guidelines for the treatment of TRD is justified and will provide better outcomes for this difficult-to-treat population.

Keywords

Meta-analysismeta-regressionpsychotherapytreatment resistant depression
Type
Review Article
Information
Psychological Medicine , Volume 49 , Issue 3 , February 2019 , pp. 366 - 379
Copyright
Copyright © Cambridge University Press 2018 

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Footnotes

*

These authors share last authorship.

References

Barker, WA, Scott, J and Eccleston, D (1987) The Newcastle chronic depression study: results of a treatment regime. International Clinical Psychopharmacology 2, 261–272.Google Scholar
Barnhofer, T, Crane, C, Hargus, E, Amarasinghe, M, Winder, R and Williams, JM (2009) Mindfulness-based cognitive therapy as a treatment for chronic depression: a preliminary study. Behaviour Research and Therapy 47, 366–373.Google Scholar
Baskin, TW, Tierney, SC, Minami, T and Wampold, BE (2003) Establishing specificity in psychotherapy: a meta-analysis of structural equivalence of placebo controls. Journal of Consulting and Clinical Psychology 71, 973.Google Scholar
Borenstein, M, Hedges, LV, Higgins, JPT and Rothstein, HR (2009) Introduction to Meta-Analysis. Wiley: NYC.Google Scholar
Budd, R and Hughes, I (2009) The Dodo Bird Verdict – controversial, inevitable and important: a commentary on 30 years of meta-analyses. Clinical Psychology & Psychotherapy 16, 510–522.Google Scholar
Carvalho, AF, Berk, M, Hyphantis, TN and McIntyre, RS (2014) The integrative management of treatment-resistant depression: a comprehensive review and perspectives. Psychotherapy and Psychosomatics 83, 70–88.Google Scholar
Chiesa, A, Castagner, V, Andrisano, C, Serretti, A, Mandelli, L, Porcelli, S and Giommi, F (2015) Mindfulness-based cognitive therapy vs. psycho-education for patients with major depression who did not achieve remission following antidepressant treatment. Psychiatry Research 226, 474–483.Google Scholar
Cuijpers, P, van Straten, A, Andersson, G and van Oppen, P (2008) Psychotherapy for depression in adults: a meta-analysis of comparative outcome studies. Journal of Consulting and Clinical Psychology 76, 909–922.Google Scholar
Cuijpers, P, Li, J, Hofmann, SG and Andersson, G (2010 a) Self-reported versus clinician-rated symptoms of depression as outcome measures in psychotherapy research on depression: a meta-analysis. Clinical Psychology Review 30, 768–778.Google Scholar
Cuijpers, P, Smit, F, Bohlmeijer, E, Hollon, SD and Andersson, G (2010 b) Efficacy of cognitive-behavioural therapy and other psychological treatments for adult depression: meta-analytic study of publication bias. The British Journal of Psychiatry 196, 173–178.Google Scholar
Cuijpers, P, van Straten, A, Schuurmans, J, van Oppen, P, Hollon, SD and Andersson, G (2010 c) Psychotherapy for chronic major depression and dysthymia: a meta-analysis. Clinical Psychology Review 30, 51–62.Google Scholar
Cuijpers, P, Sijbrandij, M, Koole, SL, Andersson, G, Beekman, AT and Reynolds, CF 3rd (2013) The efficacy of psychotherapy and pharmacotherapy in treating depressive and anxiety disorders: a meta-analysis of direct comparisons. World Psychiatry 12, 137–148.Google Scholar
Cuijpers, P, Sijbrandij, M, Koole, SL, Andersson, G, Beekman, AT and Reynolds, CF (2014) Adding psychotherapy to antidepressant medication in depression and anxiety disorders: a meta-analysis. World Psychiatry 13, 56–67.Google Scholar
Cuijpers, P, Karyotaki, E, Andersson, G, Li, J, Mergl, R and Hegerl, U (2015) The effects of blinding on the outcomes of psychotherapy and pharmacotherapy for adult depression: a meta-analysis. European Psychiatry 30, 685–693.Google Scholar
Dold, M and Kasper, S (2016) Evidence-based pharmacotherapy of treatment-resistant unipolar depression. International Journal of Psychiatry in Clinical Practice 21, 13–23.Google Scholar
Egger, M, Davey Smith, G, Schneider, M and Minder, C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315, 629–634.Google Scholar
Eisendrath, SJ, Gillung, E, Delucchi, KL, Segal, ZV, Nelson, JC, McInnes, LA, Mathalon, DH and Feldman, MD (2016) A randomized controlled trial of mindfulness-based cognitive therapy for treatment-resistant depression. Psychotherapy and Psychosomatics 85, 99–110.Google Scholar
Fonagy, P, Rost, F, Carlyle, JA, McPherson, S, Thomas, R, Pasco Fearon, RM, Goldberg, D and Taylor, D (2015) Pragmatic randomized controlled trial of long-term psychoanalytic psychotherapy for treatment-resistant depression: the Tavistock Adult Depression Study (TADS). World Psychiatry 14, 312–321.Google Scholar
Fournier, JC, DeRubeis, RJ, Hollon, SD, Dimidjian, S, Amsterdam, JD, Shelton, RC and Fawcett, J (2010) Antidepressant drug effects and depression severity: a patient-level meta-analysis. Jama 303, 47–53.Google Scholar
Gelhorn, HL, Sexton, CC and Classi, PM (2011) Patient preferences for treatment of major depressive disorder and the impact on health outcomes: a systematic review. The Primary Care Companion to CNS Disorders 13, 5.Google Scholar
Greden, JF (2001) The burden of disease for treatment-resistant depression. The Journal of Clinical Psychiatry 62(suppl. 16), 26–31.Google Scholar
Harley, R, Sprich, S, Safren, S, Jacobo, M and Fava, M (2008) Adaptation of dialectical behavior therapy skills training group for treatment-resistant depression. The Journal of Nervous and Mental Disease 196, 136–143.Google Scholar
Higgins, JPT and Green, S (2011) Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]; http://www.cochrane-handbook.org.Google Scholar
Huntley, AL, Araya, R and Salisbury, C (2012) Group psychological therapies for depression in the community: systematic review and meta-analysis. The British Journal of Psychiatry 200, 184–190.Google Scholar
Ioannidis, JP, Patsopoulos, NA and Evangelou, E (2007) Uncertainty in heterogeneity estimates in meta-analyses. BMJ 335, 914–916.Google Scholar
Jobst, A, Brakemeier, EL, Buchheim, A, Caspar, F, Cuijpers, P, Ebmeier, KP, Falkai, P, Jan van der Gaag, R, Gaebel, W, Herpertz, S, Kurimay, T, Sabass, L, Schnell, K, Schramm, E, Torrent, C, Wasserman, D, Wiersma, J and Padberg, F (2016) European psychiatric association guidance on psychotherapy in chronic depression across Europe. European Psychiatry 33, 18–36.Google Scholar
Keller, MB, McCullough, JP, Klein, DN, Arnow, B, Dunner, DL, Gelenberg, AJ, Markowitz, JC, Nemeroff, CB, Russell, JM, Thase, ME, Trivedi, MH and Zajecka, J (2000) A comparison of nefazodone, the cognitive behavioral-analysis system of psychotherapy, and their combination for the treatment of chronic depression. New England Journal of Medicine 342, 1462–1470.Google Scholar
Kennedy, SH, Segal, ZV, Cohen, NL, Levitan, RD, Gemar, M and Bagby, RM (2003) Lithium carbonate versus cognitive therapy as sequential combination treatment strategies in partial responders to antidepressant medication: an exploratory trial. The Journal of Clinical Psychiatry 64, 439–444.Google Scholar
Kocsis, JH, Gelenberg, AJ, Rothbaum, BO, Klein, DN, Trivedi, MH, Manber, R, Keller, MB, Leon, AC, Wisniewski, SR, Arnow, BA, Markowitz, JC and Thase, ME (2009) Cognitive behavioral analysis system of psychotherapy and brief supportive psychotherapy for augmentation of antidepressant nonresponse in chronic depression: the REVAMP Trial. Archives of General Psychiatry 66, 1178–1188.Google Scholar
Kolovos, S, van Tulder, MW, Cuijpers, P, Prigent, A, Chevreul, K, Riper, H and Bosmans, JE (2016) The effect of treatment as usual on major depressive disorder: a meta-analysis. Journal of Affective Disorders 210, 72–81.Google Scholar
Kriston, L, von Wolff, A, Westphal, A, Holzel, LP and Harter, M (2014) Efficacy and acceptability of acute treatments for persistent depressive disorder: a network meta-analysis. Depression and Anxiety 31, 621–630.Google Scholar
Lemmens, LH, Arntz, A, Peeters, F, Hollon, SD, Roefs, A and Huibers, MJ (2015) Clinical effectiveness of cognitive therapy v. interpersonal psychotherapy for depression: results of a randomized controlled trial. Psychological Medicine 45, 2095–2110.Google Scholar
McHugh, RK, Whitton, SW, Peckham, AD, Welge, JA and Otto, MW (2013) Patient preference for psychological vs pharmacologic treatment of psychiatric disorders: a meta-analytic review. The Journal of Clinical Psychiatry 74, 595–602.Google Scholar
McPherson, S, Cairns, P, Carlyle, J, Shapiro, DA, Richardson, P and Taylor, D (2005) The effectiveness of psychological treatments for treatment-resistant depression: a systematic review. Acta Psychiatrica Scandinavica 111, 331–340.Google Scholar
Mergl, R, Henkel, V, Allgaier, AK, Kramer, D, Hautzinger, M, Kohnen, R, Coyne, J and Hegerl, U (2011) Are treatment preferences relevant in response to serotonergic antidepressants and cognitive-behavioral therapy in depressed primary care patients? Results from a randomized controlled trial including a patients’ choice arm. Psychotherapy and Psychosomatics 80, 39–47.Google Scholar
Michalak, J, Schultze, M, Heidenreich, T and Schramm, E (2015) A randomized controlled trial on the efficacy of mindfulness-based cognitive therapy and a group version of cognitive behavioral analysis system of psychotherapy for chronically depressed patients. Journal of Consulting and Clinical Psychology 83, 951–963.Google Scholar
Moussavi, S, Chatterji, S, Verdes, E, Tandon, A, Patel, V and Ustun, B (2007) Depression, chronic diseases, and decrements in health: results from the World Health Surveys. Lancet 370, 851–858.Google Scholar
Murray, G, Michalak, EE, Axler, A, Yaxley, D, Hayashi, B, Westrin, A, Ogrodniczuk, JS, Tam, EM, Yatham, LN and Lam, RW (2010) Relief of chronic or resistant depression (Re-ChORD): a pragmatic, randomized, open-treatment trial of an integrative program intervention for chronic depression. Journal of Affective Disorders 123, 243–248.Google Scholar
Negt, P, Brakemeier, EL, Michalak, J, Winter, L, Bleich, S and Kahl, KG (2016) The treatment of chronic depression with cognitive behavioral analysis system of psychotherapy: a systematic review and meta-analysis of randomized-controlled clinical trials. Brain and Behavior 6, e00486.Google Scholar
Paykel, ES, Scott, J, Teasdale, JD, Johnson, AL, Garland, A, Moore, R, Jenaway, A, Cornwall, PL, Hayhurst, H, Abbott, R and Pope, M (1999) Prevention of relapse in residual depression by cognitive therapy. Archives of General Psychiatry 56, 829–835.Google Scholar
Peeters, FP, Ruhe, HG, Wichers, M, Abidi, L, Kaub, K, van der Lande, HJ, Spijker, J, Huibers, MJ and Schene, AH (2016) The Dutch Measure for quantification of Treatment Resistance in Depression (DM-TRD): an extension of the Maudsley Staging Method. Journal of Affective Disorders 205, 365–371.Google Scholar
Rohricht, F, Papadopoulos, N and Priebe, S (2013) An exploratory randomized controlled trial of body psychotherapy for patients with chronic depression. Journal of Affective Disorders 151, 85–91.Google Scholar
Ruhe, HG, Huyser, J, Swinkels, JA and Schene, AH (2006) Switching antidepressants after a first selective serotonin reuptake inhibitor in major depressive disorder: a systematic review. Journal of Clinical Psychiatry 67, 1836–1855.Google Scholar
Ruhe, HG, van Rooijen, G, Spijker, J, Peeters, FP and Schene, AH (2012) Staging methods for treatment resistant depression. A systematic review. Journal of Affective Disorders 137, 35–45.Google Scholar
Rush, AJ, Thase, ME and Dube, S (2003) Research issues in the study of difficult-to-treat depression. Biological Psychiatry 53, 743–753.Google Scholar
Rush, AJ, Trivedi, MH, Wisniewski, SR, Nierenberg, AA, Stewart, JW, Warden, D, Niederehe, G, Thase, ME, Lavori, PW, Lebowitz, BD, McGrath, PJ, Rosenbaum, JF, Sackeim, HA, Kupfer, DJ, Luther, J and Fava, M (2006). Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report. Am J Psychiatry, 163, 1905–1917.Google Scholar
Schramm, E, van Calker, D, Dykierek, P, Lieb, K, Kech, S, Zobel, I, Leonhart, R and Berger, M (2007) An intensive treatment program of interpersonal psychotherapy plus pharmacotherapy for depressed inpatients: acute and long-term results. American Journal of Psychiatry 164, 768–777.Google Scholar
Schramm, E, Zobel, I, Schoepf, D, Fangmeier, T, Schnell, K, Walter, H, Drost, S, Schmidt, P, Brakemeier, EL, Berger, M and Normann, C (2015) Cognitive behavioral analysis system of psychotherapy versus escitalopram in chronic major depression. Psychotherapy and Psychosomatics 84, 227–240.Google Scholar
Scott, J, Teasdale, JD, Paykel, ES, Johnson, AL, Abbott, R, Hayhurst, H, Moore, R and Garland, A (2000) Effects of cognitive therapy on psychological symptoms and social functioning in residual depression. The British Journal of Psychiatry 177, 440–446.Google Scholar
Souza, LH, Salum, GA, Mosqueiro, BP, Caldieraro, MA, Guerra, TA and Fleck, MP (2016) Interpersonal psychotherapy as add-on for treatment-resistant depression: a pragmatic randomized controlled trial. Journal of Affective Disorders 193, 373–380.Google Scholar
Spijker, J, van Straten, A, Bockting, CL, Meeuwissen, JA and van Balkom, AJ (2013) Psychotherapy, antidepressants, and their combination for chronic major depressive disorder: a systematic review. The Canadian Journal of Psychiatry 58, 386–392.Google Scholar
Stimpson, N, Agrawal, N and Lewis, G (2002) Randomised controlled trials investigating pharmacological and psychological interventions for treatment-refractory depression. Systematic review. The British Journal of Psychiatry 181, 284–294.Google Scholar
Strauss, C, Hayward, M and Chadwick, P (2012) Group person-based cognitive therapy for chronic depression: a pilot randomized controlled trial. The British Journal of Psychiatry 51, 345–350.Google Scholar
Swift, JK, Callahan, JL and Vollmer, BM (2011) Preferences. Journal of Clinical Psychology 67, 155–165.Google Scholar
Thase, ME, Friedman, ES, Biggs, MM, Wisniewski, SR, Trivedi, MH, Luther, JF, Fava, M, Nierenberg, AA, McGrath, PJ, Warden, D, Niederehe, G, Hollon, SD and Rush, AJ (2007) Cognitive therapy versus medication in augmentation and switch strategies as second-step treatments: a STAR*D report. American Journal of Psychiatry 164, 739–752.Google Scholar
Thompson, SG and Higgins, JP (2002) How should meta-regression analyses be undertaken and interpreted? Statistics in Medicine 21, 1559–1573.Google Scholar
Trivedi, RB, Nieuwsma, JA and Williams, JW Jr. (2011) Examination of the utility of psychotherapy for patients with treatment resistant depression: a systematic review. Journal of General Internal Medicine 26, 643–650.Google Scholar
Turner, EH, Matthews, AM, Linardatos, E, Tell, RA and Rosenthal, R (2008) Selective publication of antidepressant trials and its influence on apparent efficacy. New England Journal of Medicine 358, 252–260.Google Scholar
Watkins, ER, Mullan, E, Wingrove, J, Rimes, K, Steiner, H, Bathurst, N, Eastman, R and Scott, J (2011) Rumination-focused cognitive-behavioural therapy for residual depression: phase II randomised controlled trial. The British Journal of Psychiatry 199, 317–322.Google Scholar
Wiersma, JE, Van Schaik, DJ, Hoogendorn, AW, Dekker, JJ, Van, HL, Schoevers, RA, Blom, MB, Maas, K, Smit, JH, McCullough, JP Jr., Beekman, AT and Van Oppen, P (2014) The effectiveness of the cognitive behavioral analysis system of psychotherapy for chronic depression: a randomized controlled trial. Psychotherapy and Psychosomatics 83, 263–269.Google Scholar
Wiles, N, Thomas, L, Abel, A, Ridgway, N, Turner, N, Campbell, J, Garland, A, Hollinghurst, S, Jerrom, B, Kessler, D, Kuyken, W, Morrison, J, Turner, K, Williams, C, Peters, T and Lewis, G (2013) Cognitive behavioural therapy as an adjunct to pharmacotherapy for primary care based patients with treatment resistant depression: results of the CoBalT randomised controlled trial. Lancet 381, 375–384.Google Scholar
Wong, DF (2008) Cognitive behavioral treatment groups for people with chronic depression in Hong Kong: a randomized wait-list control design. Depression and Anxiety 25, 142–148.Google Scholar
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