Review: pharmacotherapy and psychotherapy similarly effective for depression in older adults.

摘要

Eighty nine controlled studies, including 70 randomised controlled trials (RCTs) met inclusion criteria. Pharmacotherapy was assessed in 62 studies and psychotherapy in 32 (5 studies tested both) over an average of 8 weeks. Pharmacotherapy and psychotherapy increased response and remission to a similar extent compared with control (see http://ebmh.bmj.com/supplemental for table). These results were not statistically heterogeneous. Pharmacotherapy and psychotherapy improved self- and clinician-rated depression compared with control, with moderate to large effect sizes (ES) (see table). These results were statistically heterogeneous. In overall analyses, psychotherapy had a greater effect on clinician-rated depression than pharmacotherapy. Restricting analyses to studies directly comparing psychotherapy, pharmacotherapy and placebo showed similar ES for both interventions (psychotherapy: -0.41, 95% CI -0.82 to -0.00; pharmacotherapy: -0.54, 95% CI -1.00 to -0.09). Psychotherapy showed larger ES than pharmacotherapy for clinician-rated depression in people with minor depression or dysthymia (psychotherapy: -1.21, 95% CI -1.42 to -1.00; pharmacotherapy -0.59; 95% CI -0.76 to -0.41) but ES were similar in people with major depression. Both interventions gave similar ES for self-rated depression for people with major depression or with minor depression or dysthymia.