Psychotherapie en farmacotherapie worden bij veel aandoeningen aanbevolen. Er zijn echter aanwijzingen dat hun werkzaamheid mogelijk wordt overschat vanwege een verscheidenheid aan tekortkomingen in klinische onderzoeken. En dus werd het tijd voor een overkoepelende review van recente meta-analyses van gerandomiseerde gecontroleerde onderzoeken (RCT’s) van psychotherapieën en farmacotherapieën voor de belangrijkste psychische stoornissen bij volwassenen.
Methode
In PubMed, PsycINFO en de Cochrane Library is gezocht naar meta-analyses die zijn gepubliceerd tussen januari 2014 en maart 2021 en waarin psychotherapieën of farmacotherapieën worden vergeleken met placebo of gebruikelijke behandeling (‘Treatment as usual’), of psychotherapieën vs. farmacotherapieën, of de combinatie van psychotherapie met farmacotherapie tot monotherapie.
Er zijn 102 meta-analyses, bestaande uit 3.782 RCT’s (n=650.514), gevonden welke de volgende psychische aandoeningen omvatten: depressieve stoornissen, angststoornissen, posttraumatische stressstoornis, obsessief-compulsieve stoornis, somatoforme stoornissen, eetstoornissen, ADHD, gebruiksstoornissen, slapeloosheid, schizofreniespectrumstoornissen en
bipolaire stoornis.
Resultaten
Bij alle aandoeningen en behandelingen waren de meeste effectgroottes voor doelsymptomen klein. Een random effect meta-analytische evaluatie van de effectgroottes gerapporteerd door de
grootste meta-analyses per aandoening leverde een gestandaardiseerd gemiddeld verschil (SMD) op van 0,34 (95% BI: 0,26-0,42) voor psychotherapieën en 0,36 (95% BI: 0,32-). 0,41) voor farmacotherapieën vergeleken met placebo of treatment as usual. De SMD voor onderlinge vergelijkingen van psychotherapieën versus farmacotherapieën was 0,11(95%-BI: ?0,05 tot 0,26). De SMD voor de gecombineerde behandeling in vergelijking met beide monotherapieën was 0,31(95%-BI: 0,19-0,44). Het risico op vooringenomenheid was vaak hoog.
Conclusie
De auteurs concluderen dat na meer dan een halve eeuw onderzoek, duizenden RCT’s en miljoenen geïnvesteerde fondsen, de effectgroottes van psychotherapieën en farmacotherapieën voor psychische stoornissen beperkt zijn.
{9309347:T47XHK4M}
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