Negative effects of psychotherapies for adult depression: A meta-analysis of deterioration rates

Summary & key facts

Researchers combined results from 18 studies that compared psychotherapy for adult depression with inactive control groups like waiting lists or usual care. They found that people who got psychotherapy were about 60% less likely to have a clinically meaningful worsening of their depression than people in the control groups. The middle (median) rate of worsening in the therapy groups was about 4%, though some studies showed more than 10% of patients getting worse. The authors say these results look encouraging, but they also warn that only a small share of all trials report worsening and many studies had some risk of bias, so we should be cautious about how strong the evidence is.

Key facts:

• The review looked at 18 studies with 23 comparisons between psychotherapy and inactive control groups for adults with depression.
• When the researchers pooled those studies, people in psychotherapy had about a 60% lower chance of clinically significant deterioration than people in control groups.
• Treating about 20 people with psychotherapy would prevent one additional case of clinically significant deterioration, compared with the control conditions.
• The median rate of clinically significant worsening in the psychotherapy groups was about 4%, although some individual studies reported more than 10% worsening.
• Only about 6% of all trials that compare psychotherapy with control groups reported data on clinically significant deterioration, so most trials do not publish this outcome.
• Most of the included studies had at least some risk of bias, and trials used different ways to define worsening, which makes the overall findings less certain.

Topics

Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes Psychotherapy Techniques and Applications Treatment of Major Depression

Categories

Health Sciences Medicine Pharmacology

Tags

Clinical psychology Confidence interval Depression (economics) Economics Internal medicine Macroeconomics Medicine Meta-analysis Psychiatry Psychology Randomized controlled trial Relative risk

Conditions & symptoms

Depression Lack of energy or motivation Sadness or low mood