Skip to main content

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
Cancel
×
×
Home
  • Home
Article
  • Cited by 5
  • Cited by
    Crossref Citations
    Crossref logo
    This article has been cited by the following publications. This list is generated based on data provided by CrossRef.
    Hengartner, Michael P. 2018. Raising Awareness for the Replication Crisis in Clinical Psychology by Focusing on Inconsistencies in Psychotherapy Research: How Much Can We Rely on Published Findings from Efficacy Trials?. Frontiers in Psychology, Vol. 9, Issue. ,
    Wang, Sheng-Min Han, Changsu Lee, Soo-Jung Jun, Tae-Youn Patkar, Ashwin A. Masand, Prakash S. and Pae, Chi-Un 2018. Efficacy of antidepressants: bias in randomized clinical trials and related issues. Expert Review of Clinical Pharmacology, Vol. 11, Issue. 1, p. 15.
    Barbato, Angelo D'Avanzo, Barbara and Parabiaghi, Alberto 2018. Couple therapy for depression. Cochrane Database of Systematic Reviews,
    Barton, Barbara Schramm, Elisabeth and Voderholzer, Ulrich 2018. Kurz- und langfristige Wirksamkeit von Psychotherapie bei Depression im Vergleich zu medikamentöser Therapie. Zeitschrift für Psychiatrie, Psychologie und Psychotherapie, Vol. 66, Issue. 1, p. 19.
    Lee, Sle Won, Jiyoon Kim, Seoyeon Park, Su Jeong and Lee, Hyangsook 2017. Spin in Randomised Clinical Trial Reports of Interventions for Obesity. Korean Journal of Acupuncture, Vol. 34, Issue. 4, p. 251.
    ×
  • Access

Sponsorship bias in the comparative efficacy of psychotherapy and pharmacotherapy for adult depression: Meta-analysis

  • Ioana A. Cristea (a1), Claudio Gentili (a2), Pietro Pietrini (a3) and Pim Cuijpers (a4)
Abstract
Background

Sponsorship bias has never been investigated for non-pharmacological treatments like psychotherapy.

Aims

We examined industry funding and author financial conflict of interest (COI) in randomised controlled trials directly comparing psychotherapy and pharmacotherapy in depression.

Method

We conducted a meta-analysis with subgroup comparisons for industry v. non-industry-funded trials, and respectively for trial reports with author financial COI v. those without.

Results

In total, 45 studies were included. In most analyses, pharmacotherapy consistently showed significant effectiveness over psychotherapy, g = −0.11 (95% CI −0.21 to −0.02) in industry-funded trials. Differences between industry and non-industry-funded trials were significant, a result only partly confirmed in sensitivity analyses. We identified five instances where authors of the original article had not reported financial COI.

Conclusions

Industry-funded trials for depression appear to subtly favour pharmacotherapy over psychotherapy. Disclosure of all financial ties with the pharmaceutical industry should be encouraged.

  • View HTML
      • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Sponsorship bias in the comparative efficacy of psychotherapy and pharmacotherapy for adult depression: Meta-analysis
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Sponsorship bias in the comparative efficacy of psychotherapy and pharmacotherapy for adult depression: Meta-analysis
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Sponsorship bias in the comparative efficacy of psychotherapy and pharmacotherapy for adult depression: Meta-analysis
      Available formats
      ×
Copyright
COPYRIGHT: © The Royal College of Psychiatrists 2017 
Corresponding author
Ioana A. Cristea, Babes-Bolyai University, Republicii 37 Street, Cluj-Napoca, Romania 400015. Email: ioana.cristea@ubbcluj.ro
Footnotes
Hide All

Declaration of interest

P.P. received speaker fees from Jansen-Cilag.

Footnotes
References
Hide All
1 Bekelman, JE, Li, Y, Gross, CP. Scope and impact of financial conflicts of interest in biomedical research: a systematic review. JAMA 2003; 289: 454–65.
2 Lundh, A, Sismondo, S, Lexchin, J, Busuioc, OA, Bero, L. Industry sponsorship and research outcome. Cochrane Database Syst Rev 2012; 12: MR000033.
3 Lexchin, J, Bero, LA, Djulbegovic, B, Clark, O. Pharmaceutical industry sponsorship and research outcome and quality: systematic review. BMJ 2003; 326: 1167–70.
4 Thompson, DF. Understanding financial conflicts of interest. N Engl J Med 1993; 329: 573–6.
5 Melander, H, Ahlqvist-Rastad, J, Meijer, G, Beermann, B. Evidence b(i)ased medicine–selective reporting from studies sponsored by pharmaceutical industry: review of studies in new drug applications. BMJ 2003; 326: 1171–3.
6 Turner, EH, Matthews, AM, Linardatos, E, Tell, RA, Rosenthal, R. Selective publication of antidepressant trials and its influence on apparent efficacy. N Engl J Med 2008; 358: 252–60.
7 Gartlehner, G, Morgan, L, Thieda, P, Fleg, A. The effect of study sponsorship on a systematically evaluated body of evidence of head-to-head trials was modest: secondary analysis of a systematic review. J Clin Epidemiol 2010; 63: 117–25.
8 Baker, CB, Johnsrud, MT, Crismon, ML, Rosenheck, RA, Woods, SW. Quantitative analysis of sponsorship bias in economic studies of antidepressants. Br J Psychiatry 2003; 183: 498–506.
9 Cuijpers, P, Sijbrandij, M, Koole, SL, Andersson, G, Beekman, AT, Reynolds, CF. The efficacy of psychotherapy and pharmacotherapy in treating depressive and anxiety disorders: a meta-analysis of direct comparisons. World Psychiatry 2013; 12: 137–48.
10 Imel, ZE, Malterer, MB, McKay, KM, Wampold, BE. A meta-analysis of psychotherapy and medication in unipolar depression and dysthymia. J Affect Disord 2008; 110: 197–206.
11 Cuijpers, P, Turner, EH, Mohr, DC, Hofmann, SG, Andersson, G, Berking, M, et al Comparison of psychotherapies for adult depression to pill placebo control groups: a meta-analysis. Psychol Med 2014; 44: 685–95.
12 National Institute for Health and Clinical Excellence. Treatment and Management of Depression in Adults, Including Adults with a Chronic Physical Health Problem. NICE, 2009.
13 Cuijpers, P, van Straten, A, Warmerdam, L, Andersson, G. Psychological treatment of depression: a meta-analytic database of randomized studies. BMC Psychiatry 2008; 8: 36.
14 Higgins, JPT, Altman, DG, Gotzsche, PC, Juni, P, Moher, D, Oxman, AD, et al The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 2011; 343: d5928.
15 Hedges, LV, Olkin, I. Statistical Methods for Meta-Analysis. Academic Press, 1985.
16 Borenstein, M, Hedges, LV, Higgins, JPT, Rothstein, HR. Introduction to Meta-Analysis. Wiley, 2009.
17 Higgins, JPT, Thompson, SG, Deeks, JJ, Altman, DG. Measuring inconsistency in meta-analyses. BMJ 2003; 327: 557–60.
18 Ioannidis, JPA, Patsopoulos, NA, Evangelou, E. Uncertainty in heterogeneity estimates in meta-analyses. BMJ 2007; 335: 914–6.
19 Orsini, N, Bottai, M, Higgins, J, Buchan, I. HETEROGI: Stata Module to Quantify Heterogeneity in a Meta-Analysis. Boston College Department of Economics, 2006 (http://econpapers.repec.org/software/bocbocode/s449201.htm).
20 Duval, S, Tweedie, R. Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 2000; 56: 455–63.
21 Borenstein, M, Hedges, LV, Higgins, JPT, Rothstein, HR. Introduction to Meta-Analysis. Wiley, 2009.
22 Barber, JP, Barrett, MS, Gallop, R, Rynn, MA, Rickels, K. Short-term dynamic psychotherapy versus pharmacotherapy for major depressive disorder: a randomized, placebo-controlled trial. J Clin Psychiatry 2012; 73: 66–73.
23 Barrett, JE, Williams, JW, Oxman, TE, Frank, E, Katon, W, Sullivan, M, et al Treatment of dysthymia and minor depression in primary care: a randomized trial in patients aged 18 to 59 years. J Fam Pract 2001; 50: 405–12.
24 Bedi, N, Chilvers, C, Churchill, R, Dewey, M, Duggan, C, Fielding, K, et al Assessing effectiveness of treatment of depression in primary care. Partially randomised preference trial. Br J Psychiatry 2000; 177: 312–8.
25 Blackburn, IM, Moore, RG. Controlled acute and follow-up trial of cognitive therapy and pharmacotherapy in out-patients with recurrent depression. Br J Psychiatry 1997; 171: 328–34.
26 Blom, MBJ, Jonker, K, Dusseldorp, E, Spinhoven, P, Hoencamp, E, Haffmans, J, et al Combination treatment for acute depression is superior only when psychotherapy is added to medication. Psychother Psychosom 2007; 76: 289–97.
27 Browne, G, Steiner, M, Roberts, J, Gafni, A, Byrne, C, Dunn, E, et al Sertraline and/or interpersonal psychotherapy for patients with dysthymic disorder in primary care: 6-month comparison with longitudinal 2-year follow-up of effectiveness and costs. J Affect Disord 2002; 68: 317–30.
28 David, D, Szentagotai, A, Lupu, V, Cosman, D. Rational emotive behavior therapy, cognitive therapy, and medication in the treatment of major depressive disorder: a randomized clinical trial, posttreatment outcomes, and six-month follow-up. J Clin Psychol 2008; 64: 728–46.
29 Dekker, JJM, Koelen, JA, Van, HL, Schoevers, RA, Peen, J, Hendriksen, M, et al Speed of action: the relative efficacy of short psychodynamic supportive psychotherapy and pharmacotherapy in the first 8 weeks of a treatment algorithm for depression. J Affect Disord 2008; 109: 183–8.
30 DeRubeis, RJ, Hollon, SD, Amsterdam, JD, Shelton, RC, Young, PR, Salomon, RM, et al Cognitive therapy vs medications in the treatment of moderate to severe depression. Arch Gen Psychiatry 2005; 62: 409–16.
31 Dimidjian, S, Hollon, SD, Dobson, KS, Schmaling, KB, Kohlenberg, RJ, Addis, ME, et al Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression. J Consult Clin Psychol 2006; 74: 658–70.
32 Dunlop, BW, Kelley, ME, Mletzko, TC, Velasquez, CM, Craighead, WE, Mayberg, HS. Depression beliefs, treatment preference, and outcomes in a randomized trial for major depressive disorder. J Psychiatr Res 2012; 46: 375–81.
33 Dunner, DL, Schmaling, KB, Hendrickson, H, Becker, J, Lehman, A, Bea, C. Cognitive therapy versus fluoxetine in the treatment of dysthymic disorder. Depression 1996; 4: 34–41.
34 Elkin, I, Shea, MT, Watkins, JT, Imber, SD, Sotsky, SM, Collins, JF, et al National Institute of Mental Health Treatment of Depression Collaborative Research Program. General effectiveness of treatments. Arch Gen Psychiatry 1989; 46: 971–82; discussion 983.
35 Faramarzi, M, Alipor, A, Esmaelzadeh, S, Kheirkhah, F, Poladi, K, Pash, H. Treatment of depression and anxiety in infertile women: cognitive behavioral therapy versus fluoxetine. J Affect Disord 2008; 108: 159–64.
36 Finkenzeller, DW, Zobel, I, Rietz, S, Schramm, E, Berger, M. Interpersonelle Psychotherapie und Pharmakotherapie bei Post-Stroke-Depression. Nervenarzt 2009; 80: 805–12.
37 Frank, E, Cassano, GB, Rucci, P, Thompson, WK, Kraemer, HC, Fagiolini, A, et al Predictors and moderators of time to remission of major depression with interpersonal psychotherapy and SSRI pharmacotherapy. Psychol Med 2011; 41: 151–62.
38 Hegerl, U, Hautzinger, M, Mergl, R, Kohnen, R, Schütze, M, Scheunemann, W, et al Effects of pharmacotherapy and psychotherapy in depressed primary-care patients: a randomized, controlled trial including a patients' choice arm. Int J Neuropsychopharmacol 2010; 13: 31–44.
39 Hollon, SD, DeRubeis, RJ, Evans, MD, Wiemer, MJ, Garvey, MJ, Grove, WM, et al Cognitive therapy and pharmacotherapy for depression. Singly and in combination. Arch Gen Psychiatry 1992; 49: 774–81.
40 Jarrett, RB, Schaffer, M, McIntire, D, Witt-Browder, A, Kraft, D, Risser, RC. Treatment of atypical depression with cognitive therapy or phenelzine: a double-blind, placebo-controlled trial. Arch Gen Psychiatry 1999; 56: 431–7.
41 Keller, MB, McCullough, JP, Klein, DN, Arnow, B, Dunner, DL, Gelenberg, AL, et al A Comparison of Nefazodone, the cognitive behavioral-analysis system of psychotherapy, and their combination for the treatment of chronic depression. New Eng J Med 2000; 342: 1462–70.
42 Kennedy, SH, Konarski, JZ, Segal, ZV, Lau, MA, Bieling, PJ, McIntyre, RS, et al Differences in brain glucose metabolism between responders to CBT and venlafaxine in a 16-week randomized controlled trial. Am J Psychiatry 2007; 164: 778–88.
43 Markowitz, JC, Kocsis, JH, Bleiberg, KL, Christos, PJ, Sacks, M. A comparative trial of psychotherapy and pharmacotherapy for ‘pure’ dysthymic patients. J Affect Disord 2005; 89: 167–75.
44 Martin, SD, Martin, E, Rai, SS, Richardson, MA, Royall, R. Brain blood flow changes in depressed patients treated with interpersonal psychotherapy or venlafaxine hydrochloride: preliminary findings. Arch Gen Psychiatry 2001; 58: 641–8.
45 Mcknight, DL, Nelson-Gray, RO, Barnhill, J. Dexamethasone suppression test and response to cognitive therapy and antidepressant medication. Behavior Therapy 1992; 23: 99–111.
46 McLean, PD, Hakstian, AR. Clinical depression: comparative efficacy of outpatient treatments. J Consult Clin Psychol 1979; 47: 818–36.
47 Menchetti, M, Rucci, P, Bortolotti, B, Bombi, A, Scocco, P, Kraemer, HC, et al Moderators of remission with interpersonal counselling or drug treatment in primary care patients with depression: randomised controlled trial. Br J Psychiatry 2014; 204: 144–50.
48 Miranda, J, Chung, JY, Green, BL, Krupnick, J, Siddique, J, Revicki, DA, et al Treating depression in predominantly low-income young minority women: a randomized controlled trial. JAMA 2003; 290: 57–65.
49 Mohr, DC, Boudewyn, AC, Goodkin, DE, Bostrom, A, Epstein, L. Comparative outcomes for individual cognitive-behavior therapy, supportive-expressive group psychotherapy, and sertraline for the treatment of depression in multiple sclerosis. J Consult Clin Psychol 2001; 69: 942–9.
50 Moradveisi, L, Huibers, MJH, Renner, F, Arasteh, M, Arntz, A. Behavioural activation v. antidepressant medication for treating depression in Iran: randomised trial. Br J Psychiatry 2013; 202: 204–11.
51 Murphy, GE, Simons, AD, Wetzel, RD, Lustman, PJ. Cognitive therapy and pharmacotherapy. Singly and together in the treatment of depression. Arch Gen Psychiatry 1984; 41: 33–41.
52 Mynors-Wallis, LM, Gath, DH, Day, A, Baker, F. Randomised controlled trial of problem solving treatment, antidepressant medication, and combined treatment for major depression in primary care. BMJ 2000; 320: 26–30.
53 Mynors-Wallis, LM, Gath, DH, Lloyd-Thomas, AR, Tomlinson, D. Randomised controlled trial comparing problem solving treatment with amitriptyline and placebo for major depression in primary care. BMJ 1995; 310: 441–5.
54 Parker, G, Blanch, B, Paterson, A, Hadzi-Pavlovic, D, Sheppard, E, Manicavasagar, V, et al The superiority of antidepressant medication to cognitive behavior therapy in melancholic depressed patients: a 12-week single-blind randomized study. Acta Psychiatr Scand 2013; 128: 271–81.
55 Quilty, LC, McBride, C, Bagby, RM. Evidence for the cognitive mediational model of cognitive behavioural therapy for depression. Psychol Med 2008; 38: 1531–41.
56 Rush, AJ, Beck, AT, Kovacs, M, Hollon, S. Comparative efficacy of cognitive therapy and pharmacotherapy in the treatment of depressed outpatients. Cogn Ther Res 1977; 1: 17–37.
57 Salminen, JK, Karlsson, H, Hietala, J, Kajander, J, Aalto, S, Markkula, J, et al Short-term psychodynamic psychotherapy and fluoxetine in major depressive disorder: a randomized comparative study. Psychother Psychosom 2008; 77: 351–7.
58 Schulberg, HC, Block, MR, Madonia, MJ, Scott, CP, Rodriguez, E, Imber, SD, et al Treating major depression in primary care practice. Eight-month clinical outcomes. Arch Gen Psychiatry 1996; 53: 913–9.
59 Scott, AL, Freeman, CP. Edinburgh primary care depression study: treatment outcome, patient satisfaction, and cost after 16 weeks. BMJ 1992; 304: 883–7.
60 Shamsaei, F, Rahimi, A, Zarabian, MK, Sedehi, M. Efficacy of pharmacotherapy and cognitive therapy, alone and in combination in major depressive disorder. Hong Kong J Psychiatry 2008; 18: 76.
61 Sharp, DJ, Chew-Graham, C, Tylee, A, Lewis, G, Howard, L, Anderson, I, et al A pragmatic randomised controlled trial to compare antidepressants with a community-based psychosocial intervention for the treatment of women with postnatal depression: the RESPOND trial. Health Technol Assess 2010; 14: iii–iv, ix–xi, 1–153.
62 Sloane, RB, Staples, FR, Schneider, LS. Interpersonal therapy vs. nortriptyline for depression in the elderly. In Clinical and Pharmacological Studies in Psychiatric Disorders (ed Burrows, GD, Norman, TR and Dennerstein, L): 344–6. John Libbey, 1985.
63 Thompson, LW, Coon, DW, Gallagher-Thompson, D, Sommer, BR, Koin, D. Comparison of desipramine and cognitive/behavioral therapy in the treatment of elderly outpatients with mild-to-moderate depression. Am J Geriatr Psychiatry 2001; 9: 225–40.
64 Weissman, MM, Prusoff, BA, Dimascio, A, Neu, C, Goklaney, M, Klerman, GL The efficacy of drugs and psychotherapy in the treatment of acute depressive episodes. Am J Psychiatry 1979; 136: 555–8.
65 Williams, JW, Barrett, J, Oxman, T, Frank, E, Katon, W, Sullivan, M, et al Treatment of dysthymia and minor depression in primary care: a randomized controlled trial in older adults. JAMA 2000; 284: 1519–26.
66 Zu, S, Xiang, Y-T, Liu, J, Zhang, L, Wang, G, Ma, X, et al A comparison of cognitive-behavioral therapy, antidepressants, their combination and standard treatment for Chinese patients with moderate-severe major depressive disorders. J Affect Disord 2014; 152–4: 262–7.
67 Imel, ZE, Malterer, MB, McKay, KM, Wampold, BE. A meta-analysis of psychotherapy and medication in unipolar depression and dysthymia. J Affect Disord 2008; 110: 197–206.
68 Cuijpers, P, Turner, EH, Koole, SL, van Dijke, A, Smit, F. What Is the threshold for a clinically relevant effect? The case of major depressive disorders. Depress Anxiety 2014; 31: 374–8.
69 Cipriani, A, Furukawa, TA, Salanti, G, Geddes, JR, Higgins, JP, Churchill, R, et al Comparative efficacy and acceptability of 12 new-generation antidepressants: a multiple-treatments meta-analysis. Lancet 2009; 373: 746–58.
70 Cuijpers, P, van Straten, A, Andersson, G, van Oppen, P. Psychotherapy for depression in adults: a meta-analysis of comparative outcome studies. J Consult Clin Psychol 2008; 76: 909–22.
71 Okike, K, Kocher, MS, Mehlman, CT, Bhandari, M. Industry-sponsored research. Injury 2008; 39: 666–80.
72 Eisner, M, Humphreys, DK, Wilson, P, Gardner, F. Disclosure of financial conflicts of interests in interventions to improve child psychosocial health: a cross-sectional study. PLoS One 2015; 10: e0142803.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
Please enter your name
Please enter a valid email address
Who would you like to send this to? *

CAPTCHA *

Skip to the audio challenge
×
Type Description Title
PDF
Supplementary materials

Cristea et al. supplementary material
Supplementary Material

 PDF (192 KB)
192 KB

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

  • Cited by 5
  • Cited by
    Crossref Citations
    Crossref logo
    This article has been cited by the following publications. This list is generated based on data provided by CrossRef.
    Hengartner, Michael P. 2018. Raising Awareness for the Replication Crisis in Clinical Psychology by Focusing on Inconsistencies in Psychotherapy Research: How Much Can We Rely on Published Findings from Efficacy Trials?. Frontiers in Psychology, Vol. 9, Issue. ,
    Wang, Sheng-Min Han, Changsu Lee, Soo-Jung Jun, Tae-Youn Patkar, Ashwin A. Masand, Prakash S. and Pae, Chi-Un 2018. Efficacy of antidepressants: bias in randomized clinical trials and related issues. Expert Review of Clinical Pharmacology, Vol. 11, Issue. 1, p. 15.
    Barbato, Angelo D'Avanzo, Barbara and Parabiaghi, Alberto 2018. Couple therapy for depression. Cochrane Database of Systematic Reviews,
    Barton, Barbara Schramm, Elisabeth and Voderholzer, Ulrich 2018. Kurz- und langfristige Wirksamkeit von Psychotherapie bei Depression im Vergleich zu medikamentöser Therapie. Zeitschrift für Psychiatrie, Psychologie und Psychotherapie, Vol. 66, Issue. 1, p. 19.
    Lee, Sle Won, Jiyoon Kim, Seoyeon Park, Su Jeong and Lee, Hyangsook 2017. Spin in Randomised Clinical Trial Reports of Interventions for Obesity. Korean Journal of Acupuncture, Vol. 34, Issue. 4, p. 251.
    ×
  • Access

Sponsorship bias in the comparative efficacy of psychotherapy and pharmacotherapy for adult depression: Meta-analysis

  • Ioana A. Cristea (a1), Claudio Gentili (a2), Pietro Pietrini (a3) and Pim Cuijpers (a4)
Submit a response

eLetters

No eLetters have been published for this article.

×

Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *

Cancel
Confirm
×