No differences between pharmacotherapy and psychotherapy for individual depression symptoms

Researchers found that medication and psychotherapy do not differ in the acute treatment of individual symptoms. The researchers' goal remains to develop a more individually adapted therapy.

Researchers evaluate symptom-based and biology-based therapy

A research team at the Max Planck Institute for Psychiatry (MPI) has now shown for the first time that medication and psychotherapy do not differ in the acute treatment of individual symptoms. The researchers' goal remains to develop a more individually adapted therapy.

Depressive patients suffer from very different symptoms. This diversity means that the symptom profile of patients is very different from one person to another. However, this individuality has so far hardly played a role in the treatment of depression. Best-proven therapy consists of a combination of medication and psychotherapy. Researchers at the Max Planck Institute for Psychiatry (MPI) have shown for the first time that the two forms of therapy do not differ in the acute treatment of individual symptoms.

In cooperation with an international team, the MPI researchers have collected study data from over 1,000 patients from four continents and analyzed 42 different symptoms using a method developed specifically for this purpose. They found that no one form of therapy is superior or inferior to the other, neither medication nor psychotherapy works better or worse than the other for individual symptoms.

"Our results do not offer any new strategies for therapy selection," summarizes study director Nils Kappelmann from the MPI, "but they do provide us with the important insight that we are currently not missing any chances when deciding between psychotherapy and medication. This is particularly important when the combination of psychotherapy and medication is not possible for medical reasons, personal preferences or simply because of limited resources".

The researchers' goal remains to develop a more individually adapted therapy. "Biological parameters might say more about the success of a form of therapy than individual symptoms," said neuroscientist and MPI Director Elisabeth Binder. Current symptom-based diagnoses and therapies do not yet differentiate between patients with different biological abnormalities. Patients who are still diagnosed with the same disease today, but who have specific disorders such as biological stress reactions or the immune system, might in future be able to benefit from personalized therapeutic approaches.

Source:
Kappelmann, N., Rein, M., Fietz, J. et al. Psychotherapy or medication for depression? Using individual symptom meta-analyses to derive a Symptom-Oriented Therapy (SOrT) metric for a personalised psychiatry. BMC Med 18, 170 (2020). https://doi.org/10.1186/s12916-020-01623-9

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