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.