Two recent meta-analyses examinedthe comparative efficacy of antidepressants versus psychotherapy in the treatment of depression and dysthymia (Cuijpers P et al., J Clin Psychiatry 2008, online ahead of print; Imel et al., J Affect Dis 2008;110:197- 206). In the acute treatment of depression, both reviews found that psychotherapyand medication did not differ in efficacy, although Cuijpers et al. found SSRIs superior to psychotherapy by a statistically significant but very small margin. In both reviews, medication was statistically significantly better than psychotherapy in treating dysthymia by a moderate effect size. Medication was linked to a significantly higher dropout rate than psychotherapy in the Cuijpers review. In studies that discontinued both treatments after a brief trial, psychotherapy led to longer term post-treatment gains than medication. Imel et al. also found that psychotherapy discontinued after an acute trial was as effective as medication continued in the longer-term, suggesting a prophylactic effect of short-term psychotherapy in reducing future episodes of depression.

TCPR’s Take: The general short- term equivalence of antidepressants and psychotherapy is in line with prior research, but some findings were surprising, particu- larly the notable superiority of medication in the treatment of dysthymia and the equivalence of short-term psychotherapy to longer-term medication treatment. The superiority for SSRIs over psychotherapyin the acute treatment of depression is interesting, but of questionable clinical significance given the very small difference in outcomes.