The symptom-specific efficacy of antidepressant medication vs. cognitive behavioral therapy in the treatment of depression: results from an individual patient data meta-analysis

Lynn Boschloo*, Ella Bekhuis, Erica S. Weitz, Mirjam Reijnders, Robert J. DeRubeis, Sona Dimidjian, David L. Dunner, Boadie W. Dunlop, Ulrich Hegerl, Steven D. Hollon, Robin B. Jarrett, Sidney H. Kennedy, Jeanne Miranda, David C. Mohr, Anne D. Simons, Gordon Parker, Frank Petrak, Stephan Herpertz, Lena C. Quilty, A. John RushZindel V. Segal, Jeffrey R. Vittengl, Robert A. Schoevers, Pim Cuijpers

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

46 Citations (Scopus)


A recent individual patient data meta-analysis showed that antidepressant medication is slightly more efficacious than cognitive behavioral therapy (CBT) in reducing overall depression severity in patients with a DSM-defined depressive disorder. We used an update of that dataset, based on seventeen randomized clinical trials, to examine the comparative efficacy of antidepressant medication vs. CBT in more detail by focusing on individual depressive symptoms as assessed with the 17-item Hamilton Rating Scale for Depression. Five symptoms (i.e., "depressed mood" , "feelings of guilt" , "suicidal thoughts" , "psychic anxiety" and "general somatic symptoms") showed larger improvements in the medication compared to the CBT condition (effect sizes ranging from .13 to .16), whereas no differences were found for the twelve other symptoms. In addition, network estimation techniques revealed that all effects, except that on "depressed mood" , were direct and could not be explained by any of the other direct or indirect treatment effects. Exploratory analyses showed that information about the symptom-specific efficacy could help in identifying those patients who, based on their pre-treatment symptomatology, are likely to benefit more from antidepressant medication than from CBT (effect size of .30) versus those for whom both treatments are likely to be equally efficacious. Overall, our symptom-oriented approach results in a more thorough evaluation of the efficacy of antidepressant medication over CBT and shows potential in "precision psychiatry" .

Original languageEnglish
Pages (from-to)183-191
Number of pages9
JournalWorld psychiatry
Issue number2
Publication statusPublished - Jun-2019


  • Depression
  • antidepressant medication
  • cognitive behavioral therapy
  • depressive symptoms
  • depressed mood
  • feelings of guilt
  • suicidal thoughts
  • psychic anxiety
  • general somatic symptoms
  • precision psychiatry

Cite this