Huhn and colleagues1 present impressive work examining the meta-analytic evidence for efficacy of psychopharmacologic and psychotherapeutic interventions for major psychiatric disorders. Performing a “meta-review” of 61 meta-analyses on 21 psychiatric disorders containing 852 trials and 137 126 participants, they present effect sizes for efficacy outcomes derived from the latest meta-analyses that compared (1) psychopharmacologic or psychotherapeutic interventions with control groups, (2) both modalities head-to-head, or (3) combination vs monotherapy strategies. Responding to the questioned efficacy of psychiatric treatments,2,3 Leucht and colleagues4 showed, in a prior meta-review of 94 meta-analyses that pooled 16 medications for 8 psychiatric disorders, an effect size comparable to that of 48 medications for 20 medical diseases (0.49 [95% CI, 0.41-0.57] vs 0.45 [0.37-0.53]). In the present meta-review,1 psychiatric medications are contrasted with psychotherapy and combination strategies for each psychiatric disorder included in the meta-analysis. In addition to adequately cautioning readers about any indirect comparison of treatment modalities, the authors advance the field by assessing the quality of the meta-analyses and even of the studies that were included in previous meta-analyses. Furthermore, they critically examine methodologic differences among pharmacotherapy and psychotherapy studies that may drive some findings.
Correll CU, Carbon M. Efficacy of Pharmacologic and Psychotherapeutic Interventions in PsychiatryTo Talk or to Prescribe: Is That the Question?. JAMA Psychiatry. 2014;71(6):624-626. doi:10.1001/jamapsychiatry.2014.301