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June 2014

Efficacy of Pharmacologic and Psychotherapeutic Interventions in Psychiatry: To Talk or to Prescribe: Is That the Question?

Author Affiliations
  • 1Division of Psychiatry Research, Department of Psychiatry, Zucker Hillside Hospital, Glen Oaks, New York
  • 2Department of Psychiatry and Molecular Medicine, Hofstra North Shore Long Island Jewish School of Medicine, Hempstead, New York
  • 3Feinstein Institute for Medical Research, Manhasset, New York
JAMA Psychiatry. 2014;71(6):624-626. doi:10.1001/jamapsychiatry.2014.301

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.

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