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Psychotherapy Versus Second-Generation Antidepressants in the Treatment of Depression: A Meta-Analysis

Spielmans, Glen I. PhD*; Berman, Margit I. PhD; Usitalo, Ashley N. BA*

The Journal of Nervous and Mental Disease: March 2011 - Volume 199 - Issue 3 - p 142-149
doi: 10.1097/NMD.0b013e31820caefb
Review Article

Most meta-analyses have concluded that psychotherapy and pharmacotherapy yield roughly similar efficacy in the short-term treatment of depression, with psychotherapy showing some advantage at long-term follow-up. However, a recent meta-analysis found that selective serotonin reuptake inhibitors medications were superior to psychotherapy in the short-term treatment of depression. To incorporate results of several recent trials into the meta-analytic literature, we conducted a meta-analysis of trials which directly compared psychotherapy to second-generation antidepressants (SGAs). Variables potentially moderating the quality of psychotherapy or medication delivery were also examined, to allow the highest quality comparison of both types of intervention. Bona fide psychotherapies showed equivalent efficacy in the short-term and slightly better efficacy on depression rating scales at follow-up relative to SGA. Non-bona fide therapies had significantly worse short-term outcomes than medication (d = 0.58). No significant differences emerged between treatments in terms of response or remission rates, but non-bona fide therapies had significantly lower rates of study completion than medication (odds ratio = 0.55). Bona fide psychotherapy appears as effective as SGAs in the short-term treatment of depression, and likely somewhat more effective than SGAs in the longer-term management of depressive symptoms.

*Department of Psychology, Metropolitan State University, St. Paul, MN; and †Department of Psychiatry, Dartmouth Medical School, Lebanon, NH.

A prior version of this paper was presented at the American Psychological Association's annual convention in Toronto in August 2009.

Glen I. Spielmans has holdings of less than $10,000 in a mutual fund (Vanguard Health Care), which invests nearly exclusively in pharmaceutical companies. Dr. Berman and Ms. Usitalo report no competing interests.

Send reprint requests to Glen I. Spielmans, PhD, Department of Psychology, Metropolitan State University, 1450 Energy Park Drive, St. Paul, MN 55108. E-mail:

© 2011 Lippincott Williams & Wilkins, Inc.