Comparative short-term efficacy and acceptability of a combination of pharmacotherapy and psychotherapy for depressive disorder in children and adolescents: a systematic review and meta-analysis
Abstract Background Although the clinical efficacy and safety of combination of pharmacotherapy and psychotherapy in the treatment of depressive disorders in children and adolescents have been studied, the results remain controversial. This meta-analysis aimed to study the short-term efficacy and ac...
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| Format: | Article |
| Language: | English |
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BMC
2022-02-01
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| Series: | BMC Psychiatry |
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| Online Access: | https://doi.org/10.1186/s12888-022-03760-2 |
| _version_ | 1818491747676717056 |
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| author | Yajie Xiang Pim Cuijpers Teng Teng Xuemei Li Li Fan Xueer Liu Yuanliang Jiang Kang Du Jingyuan Lin Xinyu Zhou Peng Xie |
| author_facet | Yajie Xiang Pim Cuijpers Teng Teng Xuemei Li Li Fan Xueer Liu Yuanliang Jiang Kang Du Jingyuan Lin Xinyu Zhou Peng Xie |
| author_sort | Yajie Xiang |
| collection | DOAJ |
| description | Abstract Background Although the clinical efficacy and safety of combination of pharmacotherapy and psychotherapy in the treatment of depressive disorders in children and adolescents have been studied, the results remain controversial. This meta-analysis aimed to study the short-term efficacy and acceptability of combined therapy for children and adolescents with depressive disorders. Methods We conducted a systematic search in multiple databases for randomised controlled trials (RCTs), up to 31 December 2020, that assessed the combination of pharmacotherapy and psychotherapy against other active treatment options (pharmacotherapy, psychotherapy and placebo combined psychotherapy) in children and adolescents ( ≤ 18 years old) with depressive disorder. This study was registered with PROSPERO (CRD42020196701). Results A total of 14 RCTs involving 1,325 patients were included. For the primary and secondary outcomes, there were no statistically significant differences between the compared interventions in terms of remission (odds ratios [OR] = 1.37; 95% confidence interval [CI]: 0.93 to 2.04), acceptability (OR = 0.99; 95% CI: 0.72 to 1.38), efficacy (standardised mean differences = -0.07; 95% CI: -0.32 to 0.19), and suicidality (OR = 1.17; 95% CI: 0.67 to 2.06). Limited evidence showed that the combination of fluoxetine (OR = 1.90, 95% CI: 1.10 to 3.29) or non-selective serotonin reuptake inhibitors (non-SSRI) (OR = 2.46, 95% CI: 1.06 to 5.72) with cognitive-behavioural therapy (CBT) was superior to other active treatment options. Most included trials were rated as ‘some concerns’ in terms of risk of bias assessment. Conclusion There is no evidence from the limited available data that all combined therapies are superior to other active treatment options for the acute treatment of depressive disorder in children and adolescents. However, it showed that fluoxetine or non-SSRI pharmacotherapies combined with CBT might be superior to other therapies in short-term. Mixed characteristics (e.g. age) and small sample size of non-SSRI combined therapy may influence the generalisability of the results. |
| first_indexed | 2024-12-10T17:35:01Z |
| format | Article |
| id | doaj.art-a7d245664c3d4d58a3e7cec51f4a5b3e |
| institution | Directory Open Access Journal |
| issn | 1471-244X |
| language | English |
| last_indexed | 2024-12-10T17:35:01Z |
| publishDate | 2022-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Psychiatry |
| spelling | doaj.art-a7d245664c3d4d58a3e7cec51f4a5b3e2022-12-22T01:39:34ZengBMCBMC Psychiatry1471-244X2022-02-0122111310.1186/s12888-022-03760-2Comparative short-term efficacy and acceptability of a combination of pharmacotherapy and psychotherapy for depressive disorder in children and adolescents: a systematic review and meta-analysisYajie Xiang0Pim Cuijpers1Teng Teng2Xuemei Li3Li Fan4Xueer Liu5Yuanliang Jiang6Kang Du7Jingyuan Lin8Xinyu Zhou9Peng Xie10Department of Neurology, the First Affiliated Hospital of Chongqing Medical UniversityDepartment of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije UniversiteitDepartment of Neurology, the First Affiliated Hospital of Chongqing Medical UniversityDepartment of Neurology, the First Affiliated Hospital of Chongqing Medical UniversityDepartment of Neurology, the First Affiliated Hospital of Chongqing Medical UniversityDepartment of Neurology, the First Affiliated Hospital of Chongqing Medical UniversityNHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, the First Affiliated Hospital of Chongqing Medical UniversityNHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, the First Affiliated Hospital of Chongqing Medical UniversityDepartment of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije UniversiteitNHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, the First Affiliated Hospital of Chongqing Medical UniversityDepartment of Neurology, the First Affiliated Hospital of Chongqing Medical UniversityAbstract Background Although the clinical efficacy and safety of combination of pharmacotherapy and psychotherapy in the treatment of depressive disorders in children and adolescents have been studied, the results remain controversial. This meta-analysis aimed to study the short-term efficacy and acceptability of combined therapy for children and adolescents with depressive disorders. Methods We conducted a systematic search in multiple databases for randomised controlled trials (RCTs), up to 31 December 2020, that assessed the combination of pharmacotherapy and psychotherapy against other active treatment options (pharmacotherapy, psychotherapy and placebo combined psychotherapy) in children and adolescents ( ≤ 18 years old) with depressive disorder. This study was registered with PROSPERO (CRD42020196701). Results A total of 14 RCTs involving 1,325 patients were included. For the primary and secondary outcomes, there were no statistically significant differences between the compared interventions in terms of remission (odds ratios [OR] = 1.37; 95% confidence interval [CI]: 0.93 to 2.04), acceptability (OR = 0.99; 95% CI: 0.72 to 1.38), efficacy (standardised mean differences = -0.07; 95% CI: -0.32 to 0.19), and suicidality (OR = 1.17; 95% CI: 0.67 to 2.06). Limited evidence showed that the combination of fluoxetine (OR = 1.90, 95% CI: 1.10 to 3.29) or non-selective serotonin reuptake inhibitors (non-SSRI) (OR = 2.46, 95% CI: 1.06 to 5.72) with cognitive-behavioural therapy (CBT) was superior to other active treatment options. Most included trials were rated as ‘some concerns’ in terms of risk of bias assessment. Conclusion There is no evidence from the limited available data that all combined therapies are superior to other active treatment options for the acute treatment of depressive disorder in children and adolescents. However, it showed that fluoxetine or non-SSRI pharmacotherapies combined with CBT might be superior to other therapies in short-term. Mixed characteristics (e.g. age) and small sample size of non-SSRI combined therapy may influence the generalisability of the results.https://doi.org/10.1186/s12888-022-03760-2Depressive disorderChildren and adolescentsCombined therapyEfficacyMeta-analysis |
| spellingShingle | Yajie Xiang Pim Cuijpers Teng Teng Xuemei Li Li Fan Xueer Liu Yuanliang Jiang Kang Du Jingyuan Lin Xinyu Zhou Peng Xie Comparative short-term efficacy and acceptability of a combination of pharmacotherapy and psychotherapy for depressive disorder in children and adolescents: a systematic review and meta-analysis BMC Psychiatry Depressive disorder Children and adolescents Combined therapy Efficacy Meta-analysis |
| title | Comparative short-term efficacy and acceptability of a combination of pharmacotherapy and psychotherapy for depressive disorder in children and adolescents: a systematic review and meta-analysis |
| title_full | Comparative short-term efficacy and acceptability of a combination of pharmacotherapy and psychotherapy for depressive disorder in children and adolescents: a systematic review and meta-analysis |
| title_fullStr | Comparative short-term efficacy and acceptability of a combination of pharmacotherapy and psychotherapy for depressive disorder in children and adolescents: a systematic review and meta-analysis |
| title_full_unstemmed | Comparative short-term efficacy and acceptability of a combination of pharmacotherapy and psychotherapy for depressive disorder in children and adolescents: a systematic review and meta-analysis |
| title_short | Comparative short-term efficacy and acceptability of a combination of pharmacotherapy and psychotherapy for depressive disorder in children and adolescents: a systematic review and meta-analysis |
| title_sort | comparative short term efficacy and acceptability of a combination of pharmacotherapy and psychotherapy for depressive disorder in children and adolescents a systematic review and meta analysis |
| topic | Depressive disorder Children and adolescents Combined therapy Efficacy Meta-analysis |
| url | https://doi.org/10.1186/s12888-022-03760-2 |
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