Baseline depression severity as moderator of depression outcomes between cognitive behavioral therapy vs pharmacotherapy: An individual patient data meta-analysis

Erica S. Weitz, Steven D. Hollon, Jos Twisk, Annemieke Van Straten, Marcus J H Huibers, Daniel David, Robert J. DeRubeis, Sona Dimidjian, Boadie W. Dunlop, Ioana A. Cristea, Mahbobeh Faramarzi, Ulrich Hegerl, Robin B. Jarrett, Farzan Kheirkhah, Sidney H. Kennedy, Roland Mergl, Jeanne Miranda, David C. Mohr, A. John Rush, Zindel V. SegalJuned Siddique, Anne D. Simons, Jeffrey R. Vittengl, Pim Cuijpers

Research output: Contribution to journalArticle

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Abstract

IMPORTANCE Current guidelines recommend treating severe depression with pharmacotherapy. Randomized clinical trials as well as traditional meta-analyses have considerable limitations in testing for moderators of treatment outcomes. OBJECTIVES To conduct a systematic literature search, collect primary data from trials, and analyze baseline depression severity as a moderator of treatment outcomes between cognitive behavioral therapy (CBT) and antidepressant medication (ADM). DATA SOURCES A total of 14 902 abstracts were examined from a comprehensive literature search in PubMed, PsycINFO, EMBASE, and Cochrane Registry of Controlled Trials from 1966 to January 1, 2014. STUDY SELECTION Randomized clinical trials in which CBT and ADM were compared in patients with a DSM-defined depressive disorder were included. DATA EXTRACTION AND SYNTHESIS Study authorswere asked to provide primary data from their trial. Primary data from 16 of 24 identified trials (67%), with 1700 outpatients (794 from the CBT condition and 906 from the ADM condition), were included. Missing data were imputed with multiple imputation methods. Mixed-effects models adjusting for study-level differences were used to examine baseline depression severity as a moderator of treatment outcomes. MAIN OUTCOMES AND MEASURES Seventeen-item Hamilton Rating Scale for Depression (HAM-D) and Beck Depression Inventory (BDI). RESULTS There was a main effect of ADM over CBT on the HAM-D (β = -0.88; P = .03) and a nonsignificant trend on the BDI (β = -1.14; P = .08, statistical test for trend), but no significant differences in response (odds ratio [OR], 1.24; P = .12) or remission (OR, 1.18; P = .22). Mixed-effects models using the HAM-D indicated that baseline depression severity does not moderate reductions in depressive symptoms between CBT and ADM at outcome (β = 0.00; P = .96). Similar results were seen using the BDI. Baseline depression severity also did not moderate the likelihood of response (OR, 0.99; P = .77) or remission (OR, 1.00; P = .93) between CBT and ADM. CONCLUSIONS AND RELEVANCE Baseline depression severity did not moderate differences between CBT and ADM on the HAM-D or BDI or in response or remission. This finding cannot be extrapolated to other psychotherapies, to individual ADMs, or to inpatients. However, it offers new and substantial evidence that is of relevance to researchers, physicians and therapists, and patients.

Original languageEnglish (US)
Pages (from-to)1102-1109
Number of pages8
JournalJAMA Psychiatry
Volume72
Issue number11
DOIs
StatePublished - Nov 1 2015

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Cognitive Therapy
Meta-Analysis
Depression
Drug Therapy
Antidepressive Agents
Odds Ratio
Equipment and Supplies
Randomized Controlled Trials
Depressive Disorder
PubMed
Psychotherapy
Registries
Inpatients
Outpatients
Research Personnel
Guidelines
Physicians

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Baseline depression severity as moderator of depression outcomes between cognitive behavioral therapy vs pharmacotherapy : An individual patient data meta-analysis. / Weitz, Erica S.; Hollon, Steven D.; Twisk, Jos; Van Straten, Annemieke; Huibers, Marcus J H; David, Daniel; DeRubeis, Robert J.; Dimidjian, Sona; Dunlop, Boadie W.; Cristea, Ioana A.; Faramarzi, Mahbobeh; Hegerl, Ulrich; Jarrett, Robin B.; Kheirkhah, Farzan; Kennedy, Sidney H.; Mergl, Roland; Miranda, Jeanne; Mohr, David C.; Rush, A. John; Segal, Zindel V.; Siddique, Juned; Simons, Anne D.; Vittengl, Jeffrey R.; Cuijpers, Pim.

In: JAMA Psychiatry, Vol. 72, No. 11, 01.11.2015, p. 1102-1109.

Research output: Contribution to journalArticle

Weitz, ES, Hollon, SD, Twisk, J, Van Straten, A, Huibers, MJH, David, D, DeRubeis, RJ, Dimidjian, S, Dunlop, BW, Cristea, IA, Faramarzi, M, Hegerl, U, Jarrett, RB, Kheirkhah, F, Kennedy, SH, Mergl, R, Miranda, J, Mohr, DC, Rush, AJ, Segal, ZV, Siddique, J, Simons, AD, Vittengl, JR & Cuijpers, P 2015, 'Baseline depression severity as moderator of depression outcomes between cognitive behavioral therapy vs pharmacotherapy: An individual patient data meta-analysis', JAMA Psychiatry, vol. 72, no. 11, pp. 1102-1109. https://doi.org/10.1001/jamapsychiatry.2015.1516
Weitz, Erica S. ; Hollon, Steven D. ; Twisk, Jos ; Van Straten, Annemieke ; Huibers, Marcus J H ; David, Daniel ; DeRubeis, Robert J. ; Dimidjian, Sona ; Dunlop, Boadie W. ; Cristea, Ioana A. ; Faramarzi, Mahbobeh ; Hegerl, Ulrich ; Jarrett, Robin B. ; Kheirkhah, Farzan ; Kennedy, Sidney H. ; Mergl, Roland ; Miranda, Jeanne ; Mohr, David C. ; Rush, A. John ; Segal, Zindel V. ; Siddique, Juned ; Simons, Anne D. ; Vittengl, Jeffrey R. ; Cuijpers, Pim. / Baseline depression severity as moderator of depression outcomes between cognitive behavioral therapy vs pharmacotherapy : An individual patient data meta-analysis. In: JAMA Psychiatry. 2015 ; Vol. 72, No. 11. pp. 1102-1109.
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TY - JOUR

T1 - Baseline depression severity as moderator of depression outcomes between cognitive behavioral therapy vs pharmacotherapy

T2 - An individual patient data meta-analysis

AU - Weitz, Erica S.

AU - Hollon, Steven D.

AU - Twisk, Jos

AU - Van Straten, Annemieke

AU - Huibers, Marcus J H

AU - David, Daniel

AU - DeRubeis, Robert J.

AU - Dimidjian, Sona

AU - Dunlop, Boadie W.

AU - Cristea, Ioana A.

AU - Faramarzi, Mahbobeh

AU - Hegerl, Ulrich

AU - Jarrett, Robin B.

AU - Kheirkhah, Farzan

AU - Kennedy, Sidney H.

AU - Mergl, Roland

AU - Miranda, Jeanne

AU - Mohr, David C.

AU - Rush, A. John

AU - Segal, Zindel V.

AU - Siddique, Juned

AU - Simons, Anne D.

AU - Vittengl, Jeffrey R.

AU - Cuijpers, Pim

PY - 2015/11/1

Y1 - 2015/11/1

N2 - IMPORTANCE Current guidelines recommend treating severe depression with pharmacotherapy. Randomized clinical trials as well as traditional meta-analyses have considerable limitations in testing for moderators of treatment outcomes. OBJECTIVES To conduct a systematic literature search, collect primary data from trials, and analyze baseline depression severity as a moderator of treatment outcomes between cognitive behavioral therapy (CBT) and antidepressant medication (ADM). DATA SOURCES A total of 14 902 abstracts were examined from a comprehensive literature search in PubMed, PsycINFO, EMBASE, and Cochrane Registry of Controlled Trials from 1966 to January 1, 2014. STUDY SELECTION Randomized clinical trials in which CBT and ADM were compared in patients with a DSM-defined depressive disorder were included. DATA EXTRACTION AND SYNTHESIS Study authorswere asked to provide primary data from their trial. Primary data from 16 of 24 identified trials (67%), with 1700 outpatients (794 from the CBT condition and 906 from the ADM condition), were included. Missing data were imputed with multiple imputation methods. Mixed-effects models adjusting for study-level differences were used to examine baseline depression severity as a moderator of treatment outcomes. MAIN OUTCOMES AND MEASURES Seventeen-item Hamilton Rating Scale for Depression (HAM-D) and Beck Depression Inventory (BDI). RESULTS There was a main effect of ADM over CBT on the HAM-D (β = -0.88; P = .03) and a nonsignificant trend on the BDI (β = -1.14; P = .08, statistical test for trend), but no significant differences in response (odds ratio [OR], 1.24; P = .12) or remission (OR, 1.18; P = .22). Mixed-effects models using the HAM-D indicated that baseline depression severity does not moderate reductions in depressive symptoms between CBT and ADM at outcome (β = 0.00; P = .96). Similar results were seen using the BDI. Baseline depression severity also did not moderate the likelihood of response (OR, 0.99; P = .77) or remission (OR, 1.00; P = .93) between CBT and ADM. CONCLUSIONS AND RELEVANCE Baseline depression severity did not moderate differences between CBT and ADM on the HAM-D or BDI or in response or remission. This finding cannot be extrapolated to other psychotherapies, to individual ADMs, or to inpatients. However, it offers new and substantial evidence that is of relevance to researchers, physicians and therapists, and patients.

AB - IMPORTANCE Current guidelines recommend treating severe depression with pharmacotherapy. Randomized clinical trials as well as traditional meta-analyses have considerable limitations in testing for moderators of treatment outcomes. OBJECTIVES To conduct a systematic literature search, collect primary data from trials, and analyze baseline depression severity as a moderator of treatment outcomes between cognitive behavioral therapy (CBT) and antidepressant medication (ADM). DATA SOURCES A total of 14 902 abstracts were examined from a comprehensive literature search in PubMed, PsycINFO, EMBASE, and Cochrane Registry of Controlled Trials from 1966 to January 1, 2014. STUDY SELECTION Randomized clinical trials in which CBT and ADM were compared in patients with a DSM-defined depressive disorder were included. DATA EXTRACTION AND SYNTHESIS Study authorswere asked to provide primary data from their trial. Primary data from 16 of 24 identified trials (67%), with 1700 outpatients (794 from the CBT condition and 906 from the ADM condition), were included. Missing data were imputed with multiple imputation methods. Mixed-effects models adjusting for study-level differences were used to examine baseline depression severity as a moderator of treatment outcomes. MAIN OUTCOMES AND MEASURES Seventeen-item Hamilton Rating Scale for Depression (HAM-D) and Beck Depression Inventory (BDI). RESULTS There was a main effect of ADM over CBT on the HAM-D (β = -0.88; P = .03) and a nonsignificant trend on the BDI (β = -1.14; P = .08, statistical test for trend), but no significant differences in response (odds ratio [OR], 1.24; P = .12) or remission (OR, 1.18; P = .22). Mixed-effects models using the HAM-D indicated that baseline depression severity does not moderate reductions in depressive symptoms between CBT and ADM at outcome (β = 0.00; P = .96). Similar results were seen using the BDI. Baseline depression severity also did not moderate the likelihood of response (OR, 0.99; P = .77) or remission (OR, 1.00; P = .93) between CBT and ADM. CONCLUSIONS AND RELEVANCE Baseline depression severity did not moderate differences between CBT and ADM on the HAM-D or BDI or in response or remission. This finding cannot be extrapolated to other psychotherapies, to individual ADMs, or to inpatients. However, it offers new and substantial evidence that is of relevance to researchers, physicians and therapists, and patients.

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