Efficacy of Pharmacotherapy and Psychotherapy for Adult Psychiatric Disorders

作者：Maximilian Huhn, Magdolna Tardy, Loukia M. Spineli, Werner Kissling, Hans Förstl, Gabriele Pitschel‐Walz, Claudia Leucht, Myrto Samara, Markus Dold, John M. Davis, Stefan Leucht · 发表于：JAMA Psychiatry · 年份：2014 · DOI：10.1001/jamapsychiatry.2014.112 · 被引用次数：340 · 研究领域：Schizophrenia research and treatment、Treatment of Major Depression、Mental Health Treatment and Access

IMPORTANCE: There is debate about the effectiveness of psychiatric treatments and whether pharmacotherapy or psychotherapy should be primarily used. OBJECTIVES: To perform a systematic overview on the efficacy of pharmacotherapies and psychotherapies for major psychiatric disorders and to compare the quality of pharmacotherapy and psychotherapy trials. EVIDENCE REVIEW: We searched MEDLINE, EMBASE, PsycINFO, and the Cochrane Library (April 2012, with no time or language limit) for systematic reviews on pharmacotherapy or psychotherapy vs placebo, pharmacotherapy vs psychotherapy, and their combination vs either modality alone. Two reviewers independently selected the meta-analyses and extracted efficacy effect sizes. We assessed the quality of the individual trials included in the pharmacotherapy and psychotherapy meta-analyses with the Cochrane risk of bias tool. FINDINGS: The search yielded 45,233 results. We included 61 meta-analyses on 21 psychiatric disorders, which contained 852 individual trials and 137,126 participants. The mean effect size of the meta-analyses was medium (mean, 0.50; 95% CI, 0.41-0.59). Effect sizes of psychotherapies vs placebo tended to be higher than those of medication, but direct comparisons, albeit usually based on few trials, did not reveal consistent differences. Individual pharmacotherapy trials were more likely to have large sample sizes, blinding, control groups, and intention-to-treat analyses. In contrast, psychotherapy trials had lower d...