Comparative analysis of clinical trials in psychotherapy and pharmacotherapy for treatment of depression
Background: Extensive evidence-based literature exists on the comparative merits of talking therapies and using antidepressant medication for the treatment of depression. However, clinical research concerning psychotherapy and pharmacotherapy is often divided along disciplinary lines, and key methodological differences exist in the conduct and reporting of clinical trials in clinical psychology and psychiatry. It is still largely unclear what the key differentiating factors as well as the predictors of effect size are in these two subfields of mental health research.
Objectives: To comparatively analyse differences in the conduct and reporting of psychotherapy and pharmacotherapy trials for the treatment of depression.
Methods: All individual trials from key meta-analyses of pharmacotherapy and psychotherapy for the treatment of depression were included in the analysis. Patient and trial characteristics as well as conflict of interest and risk of bias in relation to primary outcome measures were compared. This review was prospectively registered.
Results: Preliminary data suggest a high risk of bias and conflict of interest in both fields. Key methodological differences regarded prevalence of questionnaire and self-assessment data versus psychiatric rating scales as well as different methods of analysis, which was reflected in the primary outcome measures. Spin and issues with trial registration were prevalent in the psychotherapy literature.
Conclusions: The results of clinical trials in psychotherapy and pharmacotherapy for the treatment of depression are difficult to compare directly because of differences in methodology, patient populations, and outcome measures and should be carefully considered when making treatment recommendations.
Patient, public and/or healthcare consumer involvement: Literature on patient-identified priorities in depression research and public mental health literacy was reviewed and informed this analysis.