Change search
ReferencesLink to record
Permanent link

Direct link
Does cognitive behaviour therapy have an enduring effect that is superior to keeping patients on continuation pharmacotherapy? A meta-analysis
Vrije University of Amsterdam, Netherlands EMGO Institute Health and Care Research, Netherlands .
Vanderbilt University, TN 37235 USA .
Vrije University of Amsterdam, Netherlands EMGO Institute Health and Care Research, Netherlands .
University of Groningen, Netherlands .
Show others and affiliations
2013 (English)In: BMJ Open, ISSN 2044-6055, Vol. 3, no 4, 2542- p.Article in journal (Refereed) Published
Abstract [en]

Objectives Although cognitive behaviour therapy (CBT) and pharmacotherapy are equally effective in the acute treatment of adult depression, it is not known how they compare across the longer term. In this meta-analysis, we compared the effects of acute phase CBT without any subsequent treatment with the effects of pharmacotherapy that either were continued or discontinued across 6-18 months of follow-up. Design We conducted systematic searches in bibliographical databases to identify relevant studies, and conducted a meta-analysis of studies meeting inclusion criteria. Setting Mental healthcare. Participants Patients with depressive disorders. Interventions CBT and pharmacotherapy for depression. Outcome measures Relapse rates at long-term follow-up. Results 9 studies with 506 patients were included. The quality was relatively high. Short-term outcomes of CBT and pharmacotherapy were comparable, although drop out from treatment was significantly lower in CBT. Acute phase CBT was compared with pharmacotherapy discontinuation during follow-up in eight studies. Patients who received acute phase CBT were significantly less likely to relapse than patients who were withdrawn from pharmacotherapy (OR=2.61, 95% CI 1.58 to 4.31, pless than0.001; numbers-needed-to-be-treated, NNT=5). The acute phase CBT was compared with continued pharmacotherapy at follow-up in five studies. There was no significant difference between acute phase CBT and continued pharmacotherapy, although there was a trend (pless than0.1) indicating that patients who received acute phase CBT may be less likely to relapse following acute treatment termination than patients who were continued on pharmacotherapy (OR=1.62, 95% CI 0.97 to 2.72; NNT=10). Conclusions We found that CBT has an enduring effect following termination of the acute treatment. We found no significant difference in relapse after the acute phase CBT versus continuation of pharmacotherapy after remission. Given the small number of studies, this finding should be interpreted with caution pending replication.

Place, publisher, year, edition, pages
BMJ Publishing Group: BMJ Open / BMJ Journals , 2013. Vol. 3, no 4, 2542- p.
Keyword [en]
Mental Health
National Category
Social Sciences
URN: urn:nbn:se:liu:diva-104304DOI: 10.1136/bmjopen-2012-002542ISI: 000329809200003OAI: diva2:697156
Available from: 2014-02-17 Created: 2014-02-14 Last updated: 2014-11-28

Open Access in DiVA

fulltext(490 kB)139 downloads
File information
File name FULLTEXT01.pdfFile size 490 kBChecksum SHA-512
Type fulltextMimetype application/pdf

Other links

Publisher's full text

Search in DiVA

By author/editor
Andersson, Gerhard
By organisation
PsychologyFaculty of Arts and Sciences
In the same journal
BMJ Open
Social Sciences

Search outside of DiVA

GoogleGoogle Scholar
Total: 139 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Altmetric score

Total: 201 hits
ReferencesLink to record
Permanent link

Direct link