Sunday, September 8, 2019

Multiple meta-analyses on key mental disorders yield a picture of limited benefits for psycho- & pharmacotherapy; the overall impression is that a dead end has been reached

Leichsenring F, Steinert C, Ioannidis JPA (2019). Toward a paradigm shift in treatment and research of mental disorders. Psychological Medicine 1–7, August 7 2019.

Overall, while a certain proportion of patients (who cannot be identified in advance) does benefit from available treatments, most patients do not remit and at least half of the patients do not respond to the available treatments (Cuijpers et al., 2014; Leucht, 2014; Liet al., 2017; Springer et al., 2018). Thus, results for the efficacy of psychotherapy and pharmacotherapy are sobering, indicating only a small incremental gain over TAU or placebo and limited rates for remission and response. As noted above, this (limited) incremental gain needs to be balanced against the efforts, costs, and side effects associated with psychotherapy and pharmacotherapy. The situation is aggravated by the numerous concerns mentioned above (e.g. biases, inflated effect sizes, low rates of replication, lack of long-term studies, stagnating or decreasing effect sizes) raising serious doubts about the available evidence.

Each mental disorder raises its own host of issues. However, recent evidence across multiple meta-analyses on key mental disorders provides an overarching picture of limited benefits for both psychotherapy and pharmacotherapy. Some differences for specific disorders are not strong enough to weaken the overall impression that a dead end has been reached in the treatment of mental disorders.

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