Comparing apples and oranges in youth depression treatments? A quantitative critique of the evidence base and guidelines
Objectives Should a young person receive psychotherapy or medication for their depression and on what evidence do we base this decision? In this paper, we test the factors across modalities that may influence comparability between medication and psychotherapy trials.Methods We included 92 randomised...
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BMJ Publishing Group
2025-01-01
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| Series: | BMJ Mental Health |
| Online Access: | https://mentalhealth.bmj.com/content/28/1/e301162.full |
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| author | Samuele Cortese Glyn Lewis Argyris Stringaris Georgina Krebs Marinos Kyriakopoulos Lucy Foulkes Carmen Moreno Charlotte Burman Raphaelle Delpech Rudolph Uher Dayna Bhudia Despoina Miliou Ioannis-Marios Rokas |
| author_facet | Samuele Cortese Glyn Lewis Argyris Stringaris Georgina Krebs Marinos Kyriakopoulos Lucy Foulkes Carmen Moreno Charlotte Burman Raphaelle Delpech Rudolph Uher Dayna Bhudia Despoina Miliou Ioannis-Marios Rokas |
| author_sort | Samuele Cortese |
| collection | DOAJ |
| description | Objectives Should a young person receive psychotherapy or medication for their depression and on what evidence do we base this decision? In this paper, we test the factors across modalities that may influence comparability between medication and psychotherapy trials.Methods We included 92 randomised controlled trials (RCTs) of psychotherapy and medication for child and adolescent depression (mean age 4–18 years). Using meta-analyses, we compared (a) participant characteristics and (b) trial characteristics in medication and psychotherapy trials. Lastly, we examined whether psychotherapy controls are well-matched to active conditions.Results Participants in medication RCTs had higher depression severity and were more frequently male compared with psychotherapy RCTs. There was a dramatic difference in the within-subject improvement due to placebo (SMD=−1.9 (95% CI: −2.1 to −1.7)) vs. psychotherapy controls (SMD=−0.6 (95% CI: −0.9 to −0.3)). Within psychotherapy RCTs, control conditions were less intensive on average than active conditions.Conclusions Medication and psychotherapy RCTs differ on fundamental participant and methodological characteristics, thereby raising questions about their comparability. Psychotherapy controls often involve little therapist contact and are easy-to-beat comparators. These findings cast doubt on the confidence with which psychotherapy is recommended for youth depression and highlight the pressing need to improve the evidence base. |
| format | Article |
| id | doaj-art-1d1d62a487ac4a0998e0a1dfed15dde8 |
| institution | Kabale University |
| issn | 2755-9734 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Mental Health |
| spelling | doaj-art-1d1d62a487ac4a0998e0a1dfed15dde82025-01-22T07:15:08ZengBMJ Publishing GroupBMJ Mental Health2755-97342025-01-0128110.1136/bmjment-2024-301162Comparing apples and oranges in youth depression treatments? A quantitative critique of the evidence base and guidelinesSamuele Cortese0Glyn Lewis1Argyris Stringaris2Georgina Krebs3Marinos Kyriakopoulos4Lucy Foulkes5Carmen Moreno6Charlotte Burman7Raphaelle Delpech8Rudolph Uher9Dayna Bhudia10Despoina Miliou11Ioannis-Marios Rokas12University of Southampton, Southampton, UKUniversity College London, London, UKUniversity College London, London, UKUniversity College London, London, UKNational and Kapodistrian University of Athens, Athens, Attica, GreeceDepartment of Experimental Psychology, University of Oxford, Oxford, UKInstitute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, ISCIII, Hospital General Universitario Gregorio Marañón, Madrid, SpainUniversity College London, London, UKUniversity College London, London, UKDalhousie University, Halifax, Nova Scotia, CanadaUniversity College London, London, UKNational and Kapodistrian University of Athens, Athens, Attica, GreeceNational and Kapodistrian University of Athens, Athens, Attica, GreeceObjectives Should a young person receive psychotherapy or medication for their depression and on what evidence do we base this decision? In this paper, we test the factors across modalities that may influence comparability between medication and psychotherapy trials.Methods We included 92 randomised controlled trials (RCTs) of psychotherapy and medication for child and adolescent depression (mean age 4–18 years). Using meta-analyses, we compared (a) participant characteristics and (b) trial characteristics in medication and psychotherapy trials. Lastly, we examined whether psychotherapy controls are well-matched to active conditions.Results Participants in medication RCTs had higher depression severity and were more frequently male compared with psychotherapy RCTs. There was a dramatic difference in the within-subject improvement due to placebo (SMD=−1.9 (95% CI: −2.1 to −1.7)) vs. psychotherapy controls (SMD=−0.6 (95% CI: −0.9 to −0.3)). Within psychotherapy RCTs, control conditions were less intensive on average than active conditions.Conclusions Medication and psychotherapy RCTs differ on fundamental participant and methodological characteristics, thereby raising questions about their comparability. Psychotherapy controls often involve little therapist contact and are easy-to-beat comparators. These findings cast doubt on the confidence with which psychotherapy is recommended for youth depression and highlight the pressing need to improve the evidence base.https://mentalhealth.bmj.com/content/28/1/e301162.full |
| spellingShingle | Samuele Cortese Glyn Lewis Argyris Stringaris Georgina Krebs Marinos Kyriakopoulos Lucy Foulkes Carmen Moreno Charlotte Burman Raphaelle Delpech Rudolph Uher Dayna Bhudia Despoina Miliou Ioannis-Marios Rokas Comparing apples and oranges in youth depression treatments? A quantitative critique of the evidence base and guidelines BMJ Mental Health |
| title | Comparing apples and oranges in youth depression treatments? A quantitative critique of the evidence base and guidelines |
| title_full | Comparing apples and oranges in youth depression treatments? A quantitative critique of the evidence base and guidelines |
| title_fullStr | Comparing apples and oranges in youth depression treatments? A quantitative critique of the evidence base and guidelines |
| title_full_unstemmed | Comparing apples and oranges in youth depression treatments? A quantitative critique of the evidence base and guidelines |
| title_short | Comparing apples and oranges in youth depression treatments? A quantitative critique of the evidence base and guidelines |
| title_sort | comparing apples and oranges in youth depression treatments a quantitative critique of the evidence base and guidelines |
| url | https://mentalhealth.bmj.com/content/28/1/e301162.full |
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