Some depressed individuals may prefer psychotherapy to the use of medications, especially if their depression is not severe. By conducting a thorough assessment, a licensed and trained mental health professional can help make recommendations about an effective course of treatment for an individual's depression.

Depression can seriously impair a person's ability to function in everyday situations. But the prospects for recovery for depressed individuals who seek appropriate professional care are very good. By working with a qualified and experienced therapist, those suffering from depression can help regain control of their lives.

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What causes depression? Can depression be treated successfully? How does psychotherapy help people recover from depression? Skilled therapists such as licensed psychologists can work with depressed individuals to: pinpoint the life problems that contribute to their depression and help them understand which aspects of those problems they may be able to solve or improve.

A trained therapist can help depressed patients identify options for the future and set realistic goals that enable these individuals to enhance their mental and emotional well-being.

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Blackburn IM, Bishop S, Glen AI, Whalley LJ, Christie JE. The efficacy of cognitive therapy in depression: a treatment trial using cognitive therapy and pharmacotherapy, each alone and in combination. Blackburn I-M, Moore RG. Controlled acute and follow-up trial of cognitive therapy and pharmacotherapy in out-patients with recurrent depression.

Blom MBJ, Jonker K, Dusseldorp E, Spinhoven P, Hoencamp E, Haffmans J, et al. Combination treatment for acute depression is superior only when psychotherapy is added to medication. David D, Szentagotai A, Lupu V, Cosman D. Rational emotive behavior therapy, cognitive therapy, and medication in the treatment of major depressive disorder: a randomized clinical trial, posttreatment outcomes, and six-month follow-up.

J Clin Psychol. Dekker JJM, Koelen JA, Van HL, Schoevers RA, Peen J, Hendriksen M, et al. Speed of action: the relative efficacy of short psychodynamic supportive psychotherapy and pharmacotherapy in the first 8 weeks of a treatment algorithm for depression.

DeRubeis RJ, Hollon SD, Amsterdam JD, Shelton RC, Young PR, Salomon RM, et al. Cognitive therapy vs medications in the treatment of moderate to severe depression. Benjamini Y, Hochberg Y. Controlling the false discovery rate: a practical and powerful approach to multiple testing.

J R Stat Soc Ser B Statistical Methodol. Boschloo L, Bekhuis E, Erica S, Reijnders M, Derubeis RJ, Dimidjian S, et al. The symptom-specific efficacy of antidepressant medication vs. cognitive behavioral therapy in the treatment of depression : results from an individual patient data meta-analysis.

Cuijpers P, Noma H, Karyotaki E, Vinkers CH, Cipriani A, Furukawa TA. A network meta-analysis of the effects of psychotherapies, pharmacotherapies and their combination in the treatment of adult depression.

Craighead WE, Dunlop BW. Combination psychotherapy and antidepressant medication treatment for depression: for whom, when, and how. Annu Rev Psychol. Zilcha-Mano S, Keefe JR, Chui H, Rubin A, Barrett MS, Barber JP.

Reducing dropout in treatment for depression. Khazanov GK, Xu C, Dunn BD, Cohen ZD, DeRubeis RJ, Hollon SD. Distress and anhedonia as predictors of depression treatment outcome: a secondary analysis of a randomized clinical trial.

Fried EI, von Stockert S, Haslbeck JMB, Lamers F, Schoevers RA, Penninx BWJH. Using network analysis to examine links between individual depressive symptoms, inflammatory markers, and covariates. Jokela M, Virtanen M, Batty G, Kivimäki M. Inflammation and specific symptoms of depression.

Chu AL, Stochl J, Lewis G, Zammit S, Jones PB, Khandaker GM. Longitudinal association between inflammatory markers and specific symptoms of depression in a prospective birth cohort.

Brain Behav Immun. Lamers F, Milaneschi Y, de Jonge P, Giltay EJ, Penninx BWJH. Metabolic and inflammatory markers: associations with individual depressive symptoms. PRSice polygenic risk score software for biobank-scale data. Download references. We are grateful to all original authors, research groups, funders, and participants of original RCTs comparing psychotherapy and ADM in depression that constituted the foundation for this investigation.

We specifically thank the National Institute of Mental Health NIMH as sponsor of the Barber et al. MH [JP Barber] , Jarrett et al. We also thank Josefine Moultrie for her support in developing and piloting the search strategy and Britta Dumser for helping with the comparison of BDI and HAM-D symptoms and support on the Cochrane Risk of Bias tool.

Lastly, we thank Marc Volkert for sharing his thoughts on the choice of effect size metric for meta-analysis and formulation of the SOrT metric. This project is funded by the Max Planck Institute of Psychiatry. The MARS project was supported by grants of the German Federal Ministry of Education and Research BMBF , project no.

PReDICT study was supported by the following National Institutes of Health grants: P50 MH; R01 MH; UL1 RR; M01 RR; and the Fuqua family foundations.

Forest Labs and Elli Lilly Inc. donated the study medications, escitalopram and duloxetine, respectively, and were otherwise uninvolved in the study design, data collection, data analysis, or interpretation of findings. Max Planck Institute of Psychiatry, Kraepelinstraße , , Munich, Germany.

Nils Kappelmann, Martin Rein, Julia Fietz, Martin E. International Max Planck Research School for Translational Psychiatry IMPRS-TP , Munich, Germany. Department of Neurology and Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA. Helen S. Mayberg, W. Department of Psychology, Emory University, Atlanta, GA, USA.

Institute for Early Life Adversity Research, University of Texas Dell Medical School in Austin, Austin, TX, USA. Department of Psychiatry and Human Behavior, Brown University School of Medicine, Providence, RI, USA. Department of Psychology, Stony Brook University, Stony Brook, NY, USA.

Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, , USA. Division of Psychology and Mental Health, The University of Manchester, Manchester, UK. Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA.

Department of Psychology, Truman State University, Kirksville, MO, USA. Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.

School of Psychiatry, University of New South Wales, Sydney, NSW, Australia. Gordon F. Derner School of Psychology, Adelphi University, Garden City, New York, USA.

Contemporary Institute of Psychoanalysis and Transdisciplinarity of Porto Alegre, Porto Alegre, Brazil. Department of Research, Arkin Mental Health Care, Amsterdam, Netherlands. You can also search for this author in PubMed Google Scholar. NK had the initial idea for the project and its conceptualisation.

NK drafted the manuscript with supervision and support from JKB. NK and JKB both performed the literature search, data extraction, and risk of bias ratings. NK was responsible for all statistical analyses and figures. NK and MR were responsible for the search strategy and timeline. JF was responsible for IPD and data management sections.

HSM, WEC, BWD, CBN, MK, DNK, BAA, NH, RBJ, JRV, MM, GP, JPB, AGB, JD, and JP were responsible for providing and sharing expertise on their RCT data and related analyses.

NK and JKB assume responsibility for the accuracy and integrity of this work. All authors critically reviewed the manuscript and have given approval to the final version of the manuscript.

Correspondence to Nils Kappelmann. For the systematic review part of this study, ethics approval was not applicable as it is necessary inclusion criteria for the to-be-evaluated RCTs.

Validation of the SOrT metric was conducted using the Munich Antidepressant Response Signature MARS study and Emory Predictors of Remission in Depression to Individual and Combined Treatments PReDICT study.

MARS has received approval from the Ethics Committee of the Ludwig Maximilians University in Munich, Germany, and PReDICT from the Emory Institutional Review Board and the Grady Hospital Research Oversight Committee. Both studies were conducted in concordance with the Declaration of Helsinki [ 43 , 44 ].

Consent for publication was not generally applicable for the systematic review as the data from studies included in meta-analyses were in an individual symptom format see explanation in data extraction and acquisition section , which is fully anonymous.

However, we still checked whether authors of RCTs described that written informed consent was obtained, also because we allowed authors to send us individual patient data in case this made sharing of their data more convenient.

NK, MR, JF, BAA, AGB, MM, GP, AGB, JD, JP, and JKB do not have any competing financial or other interests relating to the content of this study.

HSM holds intellectual property in the field of deep brain stimulation for depression and is a consultant to Abbott Labs who has licenced the IP.

His research is supported by the NIH, the Mary and John Brock Foundation, and the Fuqua family foundations. He is a consultant to the George West Mental Health Foundation and is a member of the Scientific Advisory Boards of the ADAA and AIM for Mental Health.

BWD has received research support from Acadia, Assurex Health, Axsome, Intra-Cellular Therapies, Janssen, National Institute of Mental Health, and Takeda. He has served as a consultant to Assurex Health and Aptinyx. CBN has received funding from the National Institutes of Health and the Stanley Medical Research Institute.

CBN is a stockholder in Xhale, Celgene, Seattle Genetics, Abbvie, OPKO Health, Inc. MK is supported by the NIH and The John J. McDonnell and Margaret T. DNK receives grant funding from the National Institute of Mental Health NIMH.

NH is the chair of the board of trustees of Manchester Global Foundation MGF which was founded in as a Charitable Incorporated Organisation CIO registered in England and Wales. NH has attended educational events sponsored by pharmaceutical industry.

RBJ is a paid consultant to the National Institute of Mental Health and is a paid reviewer for UpToDate. She owns stock equity in Amgen, Johnson and Johnson, and Procter and Gamble.

JRV is a paid reviewer for UpToDate. JPB received medication and placebo from Pfizer and NIMH funding for the data he contributed to the present study. MEK reports the following potential conflicts of interest: speakers bureau honoraria and other continuing medical education activity: AstraZeneca Switzerland , Eli Lilly Switzerland , Lundbeck Switzerland , Vifor Switzerland , and Zeller Switzerland , as well as advisory panel payment from Lundbeck Switzerland.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Search Strategy for Identification of RCTs of Psychotherapy versus Pharmacotherapy for Depression. Content overlap assessment of Beck Depression Inventory BDI and Hamilton Rating Scale for Depression HAM-D.

Table S2- Content Overlap of HAM-D and BDI-II Items Sorted by Item Numbering. Table S3- Content Overlap of HAM-D and BDI-II Items Sorted by Equivalent Items. Table S4- Content Overlap of BDI-I and BDI-II Items Sorted by Item Numbering.

Development and considerations of a Symptom-Oriented Therapy SOrT metric. Table S5- Hypothetical SOrT Metric Computation for Three Patients. Sum-score meta-analysis results. Table S7- Meta-regression of HAM-D and BDI sum-score meta-analyses on differential dropout. S1- Funnel plot of HAM-D sum-score meta-analysis.

S2- Funnel plot of BDI sum-score meta-analysis. S3- Meta-Regression of HAM-D sum-score meta-analysis on differential dropout.

S4- Meta-Regression of BDI sum-score meta-analysis on differential dropout. S5- Funnel plot of HAM-D sum-score meta-analysis. S6- Forest plot of dropout meta-analysis. Individual symptom meta-analysis results and related sensitivity and exploratory analyses.

Table S8- Individual symptom forest plots for the HAM-D. Table S9- Individual symptom forest plots for the BDI. Table S Correlations between meta-analytic effect size metrics. S6- Effect size comparison of HAM-D and BDI per symptom type.

S7- Individual symptom effect sizes per effect size metric used in meta-analyses. S8- Associations between meta-analytic effect size metrics. S9- Effect size association to Boschloo et al. S Effect size association to Boschloo et al. for RCTs with CBT only. Validation analyses of SOrT metric in MARS and PReDICT samples and related exploratory analyses.

Table S Effect sizes of individual symptom meta-analyses with versus without Dunlop et al. Table S Linear regression analysis of week HAM-D sum-scores on SOrT-based BDI treatment allocation match following valence split.

Table S Linear regression analysis of week HAM-D sum-scores on SOrT-based treatment allocation match following median split. Table S Treatment allocation match prediction using Boschloo et al.

Table S Regression-based treatment allocation match prediction using Boschloo et al. Table S Association of symptom severity with updated SOrT scores. Table S Treatment allocation match prediction using updated SOrT metric.

S Association and distributions of HAM-D and BDI SOrT scores in PReDICT. Discussion on nominally significant treatment differences of psychotherapy and ADM for specific depressive symptoms.

Overview of available data and materials from original studies and presented work. Table S19 Availability of Original Study Data. Table S Open Access This article is licensed under a Creative Commons Attribution 4. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material.

If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. Reprints and permissions. Kappelmann, N. et al.

Psychotherapy or medication for depression? Using individual symptom meta-analyses to derive a Symptom-Oriented Therapy SOrT metric for a personalised psychiatry.

BMC Med 18 , Download citation. Received : 12 April Accepted : 07 May Published : 05 June Anyone you share the following link with will be able to read this content:. Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative.

Skip to main content. Search all BMC articles Search. Download PDF. Registered report Open access Published: 05 June Psychotherapy or medication for depression? Using individual symptom meta-analyses to derive a Symptom-Oriented Therapy SOrT metric for a personalised psychiatry Nils Kappelmann ORCID: orcid.

Mayberg 3 , 4 , W. Edward Craighead 4 , 5 , Boadie W. Dunlop 4 , Charles B. Nemeroff 6 , Martin Keller 7 , Daniel N. Klein 8 , Bruce A. Arnow 9 , Nusrat Husain 10 , Robin B. Jarrett 11 , Jeffrey R. Vittengl 12 , Marco Menchetti 13 , Gordon Parker 14 , Jacques P. Barber 15 , Andre G. Bastos 16 , Jack Dekker 17 , Jaap Peen 17 , Martin E.

Abstract Background Antidepressant medication ADM and psychotherapy are effective treatments for major depressive disorder MDD. Methods First, we conducted systematic review and meta-analyses of RCTs comparing ADM and psychotherapy at the individual symptom level.

Results The systematic review identified 38 RCTs for qualitative inclusion, 27 and 19 for quantitative inclusion at the sum-score level, and 9 and 4 for quantitative inclusion on individual symptom level for the HAM-D and BDI, respectively. Conclusions This registered report showed no differences of ADM and psychotherapy for the treatment of MDD at sum-score and symptom levels.

Methods Step 1: Systematic review and meta-analysis of RCTs of ADM versus psychotherapy Protocol registration The protocol for this systematic review was registered on PROSPERO identifier: CRD [ 45 ].

Search strategy and study selection We systematically searched PubMed Medline, PsycINFO, and Cochrane Central Register of Controlled Trials CENTRAL databases for randomised controlled trials RCTs of psychotherapy versus ADM in the treatment of depression.

Risk of bias assessment In order to assess the quality of RCTs and risk of bias, we evaluated included studies using the gold standard Cochrane Risk of Bias tool [ 47 ] while making specific adaptations of the tool to the context of psychotherapy research as was recently suggested by Munder and Barth [ 48 ].

Data acquisition and extraction The main outcome for systematic review and meta-analyses were individual symptom data. Statistical analysis The effect size for meta-analysis of depression is usually the standardised mean difference SMD when using sum-scores of depression scales. Step 2: Development and validation of the Symptom-Oriented Therapy SOrT metric Computation of the SOrT metric If our meta-analyses of individual depressive symptoms demonstrated treatment differences between ADM and psychotherapy, this would have potential benefit for the development of individualised treatment.

Timeline steps 1 and 2 We describe the planned timeline for conductance of this registered report as well as timeline adherence in Additional file 5. Results Step 1: Systematic review and meta-analysis of RCTs of ADM versus psychotherapy Literature search The literature search was conducted on 31 January and revealed reports in total.

Adapted PRISMA flow diagram. Full size image. Risk of bias ratings a overall and b for specific studies. Forest plot of HAM-D sum-score meta-analysis. Forest plot of BDI sum-score meta-analysis.

Pooled effect sizes pORs converted to SMDs on individual symptom level. Table 1 Linear regression analyses of SOrT scores on sociodemographic and clinical predictor variables in the MARS sample Full size table.

Table 2 Evaluation of SOrT-based treatment allocation Full size table. Discussion This registered report outlines a detailed investigation of the comparative effectiveness of psychotherapy and ADM for the treatment of individual depressive symptoms and whether symptom-specific effectiveness information can serve precision allocation.

Limitations The present investigation has five major limitations. Conclusion In conclusion, we report the largest symptom-specific meta-analysis of direct comparisons of psychotherapy and ADM for depression. Availability of data and materials For maximum transparency and reproducibility, we attempt to provide as much data and materials as possible.

Abbreviations ADM: Antidepressant medication BDI: Beck Depression Inventory CBT: Cognitive behavioural therapy CENTRAL: Cochrane Central Register of Controlled Trials CI: Confidence interval HAMA: Hamilton Anxiety Rating Scale HAM-D: Hamilton Rating Scale for Depression IPD: Individual patient data MARS: Munich Antidepressant Response Signature MDD: Major Depressive Disorder PAI: Personalised Advantage Index PReDICT: Emory Predictors of Remission in Depression to Individual and Combined Treatments p OR: Proportional Odds ratio RCT: Randomised controlled trial SD: Standard deviation SE: Standard error SMD: Standardised mean difference SOrT: Symptom-Oriented Therapy.

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Download references. We are grateful to all original authors, research groups, funders, and participants of original RCTs comparing psychotherapy and ADM in depression that constituted the foundation for this investigation.

We specifically thank the National Institute of Mental Health NIMH as sponsor of the Barber et al. MH [JP Barber] , Jarrett et al. We also thank Josefine Moultrie for her support in developing and piloting the search strategy and Britta Dumser for helping with the comparison of BDI and HAM-D symptoms and support on the Cochrane Risk of Bias tool.

Lastly, we thank Marc Volkert for sharing his thoughts on the choice of effect size metric for meta-analysis and formulation of the SOrT metric. This project is funded by the Max Planck Institute of Psychiatry.

The MARS project was supported by grants of the German Federal Ministry of Education and Research BMBF , project no. PReDICT study was supported by the following National Institutes of Health grants: P50 MH; R01 MH; UL1 RR; M01 RR; and the Fuqua family foundations.

Forest Labs and Elli Lilly Inc. donated the study medications, escitalopram and duloxetine, respectively, and were otherwise uninvolved in the study design, data collection, data analysis, or interpretation of findings.

Max Planck Institute of Psychiatry, Kraepelinstraße , , Munich, Germany. Nils Kappelmann, Martin Rein, Julia Fietz, Martin E. International Max Planck Research School for Translational Psychiatry IMPRS-TP , Munich, Germany. Department of Neurology and Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA. Helen S. Mayberg, W. Department of Psychology, Emory University, Atlanta, GA, USA.

Institute for Early Life Adversity Research, University of Texas Dell Medical School in Austin, Austin, TX, USA. Department of Psychiatry and Human Behavior, Brown University School of Medicine, Providence, RI, USA. Department of Psychology, Stony Brook University, Stony Brook, NY, USA.

Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, , USA. Division of Psychology and Mental Health, The University of Manchester, Manchester, UK. Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA.

Department of Psychology, Truman State University, Kirksville, MO, USA. Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.

School of Psychiatry, University of New South Wales, Sydney, NSW, Australia. Gordon F. Derner School of Psychology, Adelphi University, Garden City, New York, USA.

Contemporary Institute of Psychoanalysis and Transdisciplinarity of Porto Alegre, Porto Alegre, Brazil. Department of Research, Arkin Mental Health Care, Amsterdam, Netherlands.

You can also search for this author in PubMed Google Scholar. NK had the initial idea for the project and its conceptualisation. NK drafted the manuscript with supervision and support from JKB. NK and JKB both performed the literature search, data extraction, and risk of bias ratings.

NK was responsible for all statistical analyses and figures. NK and MR were responsible for the search strategy and timeline. JF was responsible for IPD and data management sections.

HSM, WEC, BWD, CBN, MK, DNK, BAA, NH, RBJ, JRV, MM, GP, JPB, AGB, JD, and JP were responsible for providing and sharing expertise on their RCT data and related analyses. NK and JKB assume responsibility for the accuracy and integrity of this work.

All authors critically reviewed the manuscript and have given approval to the final version of the manuscript. Correspondence to Nils Kappelmann. For the systematic review part of this study, ethics approval was not applicable as it is necessary inclusion criteria for the to-be-evaluated RCTs.

Validation of the SOrT metric was conducted using the Munich Antidepressant Response Signature MARS study and Emory Predictors of Remission in Depression to Individual and Combined Treatments PReDICT study.

MARS has received approval from the Ethics Committee of the Ludwig Maximilians University in Munich, Germany, and PReDICT from the Emory Institutional Review Board and the Grady Hospital Research Oversight Committee.

Both studies were conducted in concordance with the Declaration of Helsinki [ 43 , 44 ]. Consent for publication was not generally applicable for the systematic review as the data from studies included in meta-analyses were in an individual symptom format see explanation in data extraction and acquisition section , which is fully anonymous.

However, we still checked whether authors of RCTs described that written informed consent was obtained, also because we allowed authors to send us individual patient data in case this made sharing of their data more convenient.

NK, MR, JF, BAA, AGB, MM, GP, AGB, JD, JP, and JKB do not have any competing financial or other interests relating to the content of this study. HSM holds intellectual property in the field of deep brain stimulation for depression and is a consultant to Abbott Labs who has licenced the IP. His research is supported by the NIH, the Mary and John Brock Foundation, and the Fuqua family foundations.

He is a consultant to the George West Mental Health Foundation and is a member of the Scientific Advisory Boards of the ADAA and AIM for Mental Health. BWD has received research support from Acadia, Assurex Health, Axsome, Intra-Cellular Therapies, Janssen, National Institute of Mental Health, and Takeda.

He has served as a consultant to Assurex Health and Aptinyx. CBN has received funding from the National Institutes of Health and the Stanley Medical Research Institute.

CBN is a stockholder in Xhale, Celgene, Seattle Genetics, Abbvie, OPKO Health, Inc. MK is supported by the NIH and The John J. McDonnell and Margaret T. DNK receives grant funding from the National Institute of Mental Health NIMH. NH is the chair of the board of trustees of Manchester Global Foundation MGF which was founded in as a Charitable Incorporated Organisation CIO registered in England and Wales.

NH has attended educational events sponsored by pharmaceutical industry. RBJ is a paid consultant to the National Institute of Mental Health and is a paid reviewer for UpToDate. She owns stock equity in Amgen, Johnson and Johnson, and Procter and Gamble. JRV is a paid reviewer for UpToDate.

JPB received medication and placebo from Pfizer and NIMH funding for the data he contributed to the present study. MEK reports the following potential conflicts of interest: speakers bureau honoraria and other continuing medical education activity: AstraZeneca Switzerland , Eli Lilly Switzerland , Lundbeck Switzerland , Vifor Switzerland , and Zeller Switzerland , as well as advisory panel payment from Lundbeck Switzerland.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Search Strategy for Identification of RCTs of Psychotherapy versus Pharmacotherapy for Depression. Content overlap assessment of Beck Depression Inventory BDI and Hamilton Rating Scale for Depression HAM-D.

Table S2- Content Overlap of HAM-D and BDI-II Items Sorted by Item Numbering. Table S3- Content Overlap of HAM-D and BDI-II Items Sorted by Equivalent Items. Table S4- Content Overlap of BDI-I and BDI-II Items Sorted by Item Numbering. Development and considerations of a Symptom-Oriented Therapy SOrT metric.

Table S5- Hypothetical SOrT Metric Computation for Three Patients. Sum-score meta-analysis results. Table S7- Meta-regression of HAM-D and BDI sum-score meta-analyses on differential dropout.

S1- Funnel plot of HAM-D sum-score meta-analysis. S2- Funnel plot of BDI sum-score meta-analysis. S3- Meta-Regression of HAM-D sum-score meta-analysis on differential dropout. S4- Meta-Regression of BDI sum-score meta-analysis on differential dropout. S5- Funnel plot of HAM-D sum-score meta-analysis.

S6- Forest plot of dropout meta-analysis. Individual symptom meta-analysis results and related sensitivity and exploratory analyses. Table S8- Individual symptom forest plots for the HAM-D. Table S9- Individual symptom forest plots for the BDI.

Table S Correlations between meta-analytic effect size metrics. S6- Effect size comparison of HAM-D and BDI per symptom type. S7- Individual symptom effect sizes per effect size metric used in meta-analyses. S8- Associations between meta-analytic effect size metrics. S9- Effect size association to Boschloo et al.

S Effect size association to Boschloo et al. for RCTs with CBT only. Validation analyses of SOrT metric in MARS and PReDICT samples and related exploratory analyses. Table S Effect sizes of individual symptom meta-analyses with versus without Dunlop et al.

Table S Linear regression analysis of week HAM-D sum-scores on SOrT-based BDI treatment allocation match following valence split. Table S Linear regression analysis of week HAM-D sum-scores on SOrT-based treatment allocation match following median split. Table S Treatment allocation match prediction using Boschloo et al.

Table S Regression-based treatment allocation match prediction using Boschloo et al. Table S Association of symptom severity with updated SOrT scores. Table S Treatment allocation match prediction using updated SOrT metric. S Association and distributions of HAM-D and BDI SOrT scores in PReDICT.

Discussion on nominally significant treatment differences of psychotherapy and ADM for specific depressive symptoms. Overview of available data and materials from original studies and presented work. Table S19 Availability of Original Study Data.

Table S Open Access This article is licensed under a Creative Commons Attribution 4. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material.

If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. Reprints and permissions.

Kappelmann, N. et al. Psychotherapy or medication for depression? Using individual symptom meta-analyses to derive a Symptom-Oriented Therapy SOrT metric for a personalised psychiatry. BMC Med 18 , Download citation. Received : 12 April Accepted : 07 May Published : 05 June Anyone you share the following link with will be able to read this content:.

Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative. Skip to main content. Search all BMC articles Search. Download PDF. Registered report Open access Published: 05 June Psychotherapy or medication for depression?

Using individual symptom meta-analyses to derive a Symptom-Oriented Therapy SOrT metric for a personalised psychiatry Nils Kappelmann ORCID: orcid. Mayberg 3 , 4 , W. Edward Craighead 4 , 5 , Boadie W. Dunlop 4 , Charles B. Nemeroff 6 , Martin Keller 7 , Daniel N. Klein 8 , Bruce A. Arnow 9 , Nusrat Husain 10 , Robin B.

Jarrett 11 , Jeffrey R. Vittengl 12 , Marco Menchetti 13 , Gordon Parker 14 , Jacques P. Barber 15 , Andre G. Bastos 16 , Jack Dekker 17 , Jaap Peen 17 , Martin E. Abstract Background Antidepressant medication ADM and psychotherapy are effective treatments for major depressive disorder MDD.

Methods First, we conducted systematic review and meta-analyses of RCTs comparing ADM and psychotherapy at the individual symptom level.

Results The systematic review identified 38 RCTs for qualitative inclusion, 27 and 19 for quantitative inclusion at the sum-score level, and 9 and 4 for quantitative inclusion on individual symptom level for the HAM-D and BDI, respectively. Conclusions This registered report showed no differences of ADM and psychotherapy for the treatment of MDD at sum-score and symptom levels.

Methods Step 1: Systematic review and meta-analysis of RCTs of ADM versus psychotherapy Protocol registration The protocol for this systematic review was registered on PROSPERO identifier: CRD [ 45 ].

Search strategy and study selection We systematically searched PubMed Medline, PsycINFO, and Cochrane Central Register of Controlled Trials CENTRAL databases for randomised controlled trials RCTs of psychotherapy versus ADM in the treatment of depression.

Risk of bias assessment In order to assess the quality of RCTs and risk of bias, we evaluated included studies using the gold standard Cochrane Risk of Bias tool [ 47 ] while making specific adaptations of the tool to the context of psychotherapy research as was recently suggested by Munder and Barth [ 48 ].

Data acquisition and extraction The main outcome for systematic review and meta-analyses were individual symptom data. Statistical analysis The effect size for meta-analysis of depression is usually the standardised mean difference SMD when using sum-scores of depression scales.

Step 2: Development and validation of the Symptom-Oriented Therapy SOrT metric Computation of the SOrT metric If our meta-analyses of individual depressive symptoms demonstrated treatment differences between ADM and psychotherapy, this would have potential benefit for the development of individualised treatment.

Timeline steps 1 and 2 We describe the planned timeline for conductance of this registered report as well as timeline adherence in Additional file 5.

Results Step 1: Systematic review and meta-analysis of RCTs of ADM versus psychotherapy Literature search The literature search was conducted on 31 January and revealed reports in total. Adapted PRISMA flow diagram.

Full size image. Risk of bias ratings a overall and b for specific studies. Forest plot of HAM-D sum-score meta-analysis. Forest plot of BDI sum-score meta-analysis. Pooled effect sizes pORs converted to SMDs on individual symptom level. Table 1 Linear regression analyses of SOrT scores on sociodemographic and clinical predictor variables in the MARS sample Full size table.

Table 2 Evaluation of SOrT-based treatment allocation Full size table. Discussion This registered report outlines a detailed investigation of the comparative effectiveness of psychotherapy and ADM for the treatment of individual depressive symptoms and whether symptom-specific effectiveness information can serve precision allocation.

Limitations The present investigation has five major limitations. Conclusion In conclusion, we report the largest symptom-specific meta-analysis of direct comparisons of psychotherapy and ADM for depression. Availability of data and materials For maximum transparency and reproducibility, we attempt to provide as much data and materials as possible.

Abbreviations ADM: Antidepressant medication BDI: Beck Depression Inventory CBT: Cognitive behavioural therapy CENTRAL: Cochrane Central Register of Controlled Trials CI: Confidence interval HAMA: Hamilton Anxiety Rating Scale HAM-D: Hamilton Rating Scale for Depression IPD: Individual patient data MARS: Munich Antidepressant Response Signature MDD: Major Depressive Disorder PAI: Personalised Advantage Index PReDICT: Emory Predictors of Remission in Depression to Individual and Combined Treatments p OR: Proportional Odds ratio RCT: Randomised controlled trial SD: Standard deviation SE: Standard error SMD: Standardised mean difference SOrT: Symptom-Oriented Therapy.

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Chapter Google Scholar Chinn S. Article CAS PubMed Google Scholar Viechtbauer W. Depression is a serious mental health disorder that causes persistent feelings of sadness, hopelessness, and a loss of interest in activities.

It can interfere with daily life and affect your ability to work, go to school, and participate in activities. When suffering from depression, psychotherapy is often recommended as a way to manage symptoms.

Many types of psychotherapy can benefit those with depression, some of which are cognitive behavioral therapy CBT , dialectical behavioral therapy DBT , and interpersonal therapy IPT.

Keep reading to learn more about each and see if one or more sounds like it could help you find relief. Cognitive Behavioral Therapy CBT is a form of psychotherapy that is used to address problems with emotions, behavior, and thought patterns.

It focuses on identifying, understanding, and changing any negative thoughts we may have. The goal of CBT is to help you build self-awareness as well as learn new skills to cope with your feelings.

Then, you can use the coping skills you learn in therapy to modify your behavior to reduce your distress. Many therapists use CBT with their patients, for countless conditions. Learn more about how CBT could benefit you.

CBT typically requires between sessions to be effective. During therapy, the CBT therapist will work together with you to identify cognitive and behavioral patterns that are causing distress.

From there, the CBT therapist will help you learn new skills and strategies to replace those old patterns or beliefs that are no longer beneficial. This process can involve cognitive restructuring, which is changing your thoughts to respond differently. It can also involve exposure therapy to help reduce anxiety or fear and relaxation techniques to help reduce stress.

Overall, CBT is a helpful form of psychotherapy that can provide an effective treatment for many different kinds of mental health issues. It can help treat depression , anxiety , post-traumatic stress disorder PTSD , and phobias.

It can also help to build confidence and improve relationships. CBT can be effective on its own and when used in combination with medications. Through CBT, you can gain an understanding of your behaviors, reactions, and emotions, and learn tools to be more mindful and respond more effectively.

Dialectical Behavioral Therapy DBT is a type of psychotherapy that focuses on helping to develop new coping strategies and ways of thinking to better regulate emotions and behavior. It has been used successfully for treating a range of issues, including depression , anxiety , eating disorders, PTSD , and personality disorders.

DBT looks into your patterns of behavior, emotions, and how you relate to others. One of the key components of DBT is dialectics. Dialectics is the art of resolving conflicts. It approaches conflicts with an understanding that most things in life do not have one right answer, but rather multiple ways of looking at it.

This concept applies to the way you think and feel, and it can help with accepting and balancing the differences between thoughts and feelings.

Accepting these differences can help you learn to tolerate distress without becoming overwhelmed and develop healthier ways of coping. In addition, DBT emphasizes the importance of mindfulness.

Mindfulness is the practice of being present in the moment and can help a person to observe their thoughts, feelings, and behaviors without judgment. DBT also emphasizes building skills such as emotion regulation, distress tolerance, and interpersonal effectiveness.

This can help you better identify and regulate your emotions, as well as build self-respect and interpersonal skills. Overall, DBT is a form of psychotherapy that can be helpful for many different types of mental health issues, particularly when combined with medications.

It is beneficial for teaching people effective strategies to regulate emotions and behavior, developing healthier ways of thinking, and building interpersonal skills and self-respect. Furthermore, the emphasis on mindfulness, skills-building, and dialectics can be effective and helpful for managing stress and learning to take life one moment at a time.

Interpersonal Therapy IPT is a form of psychotherapy used to treat a variety of mental health issues. It was initially developed to treat depression but has since been applied to many other mental health disorders.

IPT is based on the idea that our interpersonal relationships can majorly impact our psychological well-being.

Because every individual is different and often dealing with a unique set of circumstances, the number of therapy sessions needed to produce results can vary considerably. However, there are some common factors, which can influence the length of time it takes to establish and maintain recovery:.

Treatment length for Mild to Moderate Depression or Bouts of Depression Psychotherapy demonstrates high success rates as a treatment with mild to moderate depression. As a general rule, for mild to moderate depression anything ranging from 6—12 or 24 sessions can produce good results.

When the influencing factors accompanying the moderate depression are more extreme, some people find more than 24 sessions would be required to tackle issues, embed new strategies and feel equipped to maintain lasting changing.

Treatment Length for Severe Clinical Depression In cases of severe clinical depression, psychotherapy alone is often not sufficient. In severe cases more than 24 sessions and sometimes more than one session a week, could be required, in order to develop the ability to manage symptoms.

Treatment Length with Different Therapuetic Approaches Some of the more modern therapies such as CBT, solution focussed therapy and integrative therapy an approach that integrates a range of therapies — depending on the training and interest of the practitioner view change as possible within a fewer number of sessions than older traditional therapies such as analytic and psychodynamic approaches, which have historically held the view that change takes a long time, often many years.

However, there are now newer forms of psychodynamic therapy that do work within a shorter frame of 10 sessions. There is a considerable range of psychotherapy approaches which have demonstrated success in treating depression.

Below is a selection of some of the most common ones in use today. Nowadays, many therapists are trained in more than one psychotherapy approach. This is commonly known as integrative psychotherapy. Integrative therapists can draw on a range of theories and techniques, which can help tackle depression symptoms from a range of different angles.

The most common therapies they will be trained in are: psychodynamic , person centred and CBT see more about these below. An experienced integrative therapist should be able to work effectively within a brief time frame and also have the skills to help you tackle more long-standing symptoms of depression.

It demonstrates good success rates in treating mild to moderate depression. CBT provides some excellent exercises and tools that can help you understand depression cycles and symptoms and help you devise strategies to address them effectively.

Homework assignments are agreed upon with your therapist so you can develop your skills outside of the therapy, using specific exercises to address areas of difficulty. However, the government have discovered that CBT is not always the best treatment for every individual and other therapies are needed to bridge this gap.

Interpersonal Therapy is a relatively new therapy provided by the NHS to address the fact that CBT is not suitable for treating all cases of depression. In essence, IPT shares many similarities to most other forms of psychotherapy such as integrative, psychodynamic and humanistic, which have been in existence for many years and also show good evidence of effectiveness with depression.

Psychodynamic psychotherapy is one of the oldest of the modern therapies. It helps people understand the influence that their past has on their current emotional state as well as their actions and helps them deal with unresolved conflicts. This type of therapy also gives people better ways to deal with challenging situations.

In addition to depression, it can also help with addictions, anxiety, and eating disorders. It has a strong focus on the here and now, and it focuses on the way personal responsibility is connected to self-empowerment. It treats depression as a chance for you to grow and develop your full potential.

There is a wide range of therapies that fall under the humanistic therapy banner which include: person centred psychotherapy, transactional analysis, existential psychotherapy and gestalt psychotherapy.

A trusting relationship with your psychotherapist is the key to feeling better. If you do not feel comfortable sharing confidences after about two to three sessions, you might want to find a therapist who is a better match.

Whilst it is true that therapy can be challenging at times, this is simply because you are dealing with issues which have made you feel depressed.

Therefore, touching upon these is bound to bring up feelings. However, you should not be feeling overwhelmed, over-exposed or really confused. A well matched depression psychotherapist will support you to explore important issues, at a pace that you feel in control of.

You should feel safe, understood and contained and that you are growing and learning through the difficult patches. It is also important to keep in mind that some people who suffer from severe depression or bipolar disorder might not see benefits from psychotherapy alone.

In these cases, a combined approach of psychotherapy and medication may be more beneficial. Private depression psychotherapists can be found on google and through directories including those of the main clinical governing bodies noted below.

You can also ask family members or friends for recommendations. On the NHS a general practitioner, social worker, or other health professional can refer you to a psychotherapist and you can self refer via the Increasing Access to Psychological Therapies IAPT Scheme. You can also access psychotherapy for depression in the charity sector, the largest mental health charity in the UK is MIND and they have branches in different boroughs of London and throughout the UK, many of which offer psychotherapy.

Make sure the therapist you choose is registered with a recognised governing body that regulates the quality of psychotherapy provision in the UK such as UKCP , HCPC , or BACP.

How can Cognitive Behavioural Therapy Help Treat Depression? NICE Guidelines for Depression. Boundaries define the limits of acceptable behaviour and are critical for our well-being.

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Maggie can help match you with the right therapist based on your needs. This guide will address the following common questions regarding psychotherapy and depression: What Causes Depression?

How to Find a Depression Psychotherapist According to the Office for National Statistics, mixed depression and anxiety is the most common mental health problem in Britain, affecting nearly one-fifth of adults.

It can be developed for a number of different reasons, some include: Stressful life events. An upsetting incident such as a death in the family or the breakdown of a romantic relationship can lead people to depression. Job stress or financial woes are also common causes.

Early life experiences can also play a role. People who try to deal with these issues on their own and shut themselves off from family and friends are especially vulnerable to developing depression.

Personality and heredity. People who have certain personality traits are also susceptible to depression. Those who are excessively self-critical or have very low self-esteem are at particular risk.

Moreover, if you have a family history of depression — such as a depressed parent or sibling — it is possible you could become depressed yourself. However, this is not a given, many people with such histories do not become depressed. Department of Defense and NIMH and royalties from American Psychiatric Association Publishing, Basic Books, and Oxford University Press.

Wright reports equity interest and consulting with Mindstreet, Inc. Peeters receives royalties from Boom Publishers, Bohn Stafleu van Loghum, and Hogrefe Publishing Group, receives research grants from Zon-MW and the Mitialto Foundation, and received financial compensation as an independent symposium speaker for Janssen-Cilag and SCEM.

Thase has served as an adviser or consultant for Acadia, Akili, Alkermes, Allergan Forest, Naurex , Boehringer-Ingelheim, Clexio Biosciences, H.

Kocsis reports no conflicts of interest. Sudak receives book royalties from American Psychiatric Association Publishing, John Wiley and Sons, and Wolters-Kluwer. Eur Neuropsychopharmacol ; —91 Crossref , Medline , Google Scholar.

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Forgot your Username? Enter your email address below and we will send you your username. Back to table of contents. Previous article. Commentary Full Access. John C. Markowitz Search for more papers by this author. Jesse H. Wright Search for more papers by this author.

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Add to favorites Download Citations Track Citations. Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons and New York State Psychiatric Institute, New York Markowitz ; Department of Psychiatry and Behavioral Sciences, University of Louisville, Louisville Wright ; Department of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands Peeters ; Department of Psychiatry, University of Pennsylvania, Philadelphia Thase ; Department of Psychiatry, Weill Medical College of Cornell University, New York Kocsis ; Department of Psychiatry, Drexel University, Philadelphia Sudak.

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