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Efficacia di Farmacoterapia e Psicoterapia a confronto

Efficacy of Pharmacotherapy and Psychotherapy

for Adult Psychiatric Disorders

A Systematic Overview of Meta-analyses


Maximilian Huhn, MD; Magdolna Tardy, MSc; Loukia Maria Spineli, MSc;Werner Kissling, MD;

Hans F.rstl, MD; Gabriele Pitschel-Walz, PhD; Claudia Leucht, MD; Myrto Samara, MD; Markus Dold, MD;

John M. Davis, MD; Stefan Leucht,MD


IMPORTANCE There is debate about the effectiveness of psychiatric treatments and whether

pharmacotherapy or psychotherapy should be primarily used.

OBJECTIVES To perform a systematic overview on the efficacy of pharmacotherapies and

psychotherapies for major psychiatric disorders and to compare the quality of

pharmacotherapy and psychotherapy trials.

EVIDENCE REVIEW We searched MEDLINE, EMBASE, PsycINFO, and the Cochrane Library

(April 2012, with no time or language limit) for systematic reviews on pharmacotherapy or

psychotherapy vs placebo, pharmacotherapy vs psychotherapy, and their combination vs

either modality alone. Two reviewers independently selected the meta-analyses and

extracted efficacy effect sizes.We assessed the quality of the individual trials included in the

pharmacotherapy and psychotherapymeta-analyses with the Cochrane risk of bias tool.

FINDINGS The search yielded 45 233 results.We included 61 meta-analyses on 21 psychiatric

disorders, which contained 852 individual trials and 137 126 participants. The mean effect size

of the meta-analyses was medium (mean, 0.50; 95%CI, 0.41-0.59). Effect sizes of

psychotherapies vs placebo tended to be higher than those of medication, but direct

comparisons, albeit usually based on few trials, did not reveal consistent differences.

Individual pharmacotherapy trials were more likely to have large sample sizes, blinding,

control groups, and intention-to-treat analyses. In contrast, psychotherapy trials had lower

dropout rates and provided follow-up data. In psychotherapy studies, wait-list designs

showed larger effects than did comparisons with placebo.

CONCLUSIONS AND RELEVANCE Many pharmacotherapies and psychotherapies are effective,

but there is a lot of room for improvement. Because of the multiple differences in the

methods used in pharmacotherapy and psychotherapy trials, indirect comparisons of their

effect sizes compared with placebo or no treatment are problematic.Well-designed direct

comparisons, which are scarce, need public funding. Because patients often benefit from

both forms of therapy, research should also focus on how both modalities can be best

combined to maximize synergy rather than debate the use of one treatment over the other.




Efficacia di Farmacoterapia e Psicoterapia a confronto

09 Sep 2015

JAMA Psychiatry. doi:10.1001/jamapsychiatry.2014.112 Published online April 30, 2014. [continua]

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