Efficacy versus effectiveness: a direct comparison of the outcome of treatment for mild to moderate depression in randomized controlled trials and daily practice

Psychotherapy and Psychosomatics
Rosalind van der LemFrans G Zitman

Abstract

Results from randomized controlled trials (RCTs) are considered to give the most reliable information on treatment outcome (efficacy). Yet, the generalizability of efficacy results to daily practice (effectiveness) might be diminished by the design of RCTs. The STAR*D trial approached daily practice as much as possible, but still has some properties of an RCT. In this study, we compare results from treatment of major depressive disorder (MDD) in routine clinical practice to those of RCTs and STAR*D. Effectiveness in routine clinical practice was compared with efficacy results from 15 meta-analyses on antidepressant, psychotherapeutic and combination treatment and results from STAR*D. Data on daily practice patients and treatments were derived from a routine outcome monitoring (ROM) system. Treatment outcome was defined as proportion of remitters (MADRS ≤10) and within-group effect size. From ROM, 598 patients suffering from a MDD episode according to the MINI-plus were included. Remission percentages were lower in routine practice than in meta-analyses for all treatment modalities (32 vs.40-74%). Differences were less explicit for antidepressants (21 vs. 34-47%) than for individual psychotherapy (27 vs. 34-58%; effect size 0.85...Continue Reading

References

Jan 1, 1978·Acta Psychiatrica Scandinavica. Supplementum·M AsbergG Sedvall
May 1, 1992·The Journal of Nervous and Mental Disease·B E Wexler, D V Cicchetti
May 1, 1992·The American Journal of Psychiatry·J W StewartF M Quitkin
Dec 1, 1967·The British Journal of Social and Clinical Psychology·M Hamilton
May 1, 1997·European Neuropsychopharmacology : the Journal of the European College of Neuropsychopharmacology·S KasperA G Pols
Mar 1, 1997·The British Journal of Psychiatry : the Journal of Mental Science·R W LichtM Frydenberg
Nov 21, 1997·Archives of General Psychiatry·M E ThaseD J Kupfer
Jan 1, 1997·Depression and Anxiety·D C SteffensM J Helms
Apr 25, 2000·Psychological Reports·N SchmitzG H Franke
Jul 27, 2000·The British Journal of Psychiatry : the Journal of Mental Science·P BechG D Tollefson
Mar 7, 2001·The British Journal of Psychiatry : the Journal of Mental Science·M E ThaseR L Rudolph
Apr 21, 2001·European Neuropsychopharmacology : the Journal of the European College of Neuropsychopharmacology·J G StorosumA W Broekmans
Aug 30, 2002·Journal of Affective Disorders·C J HawleyUNKNOWN Hertfordshire Neuroscience Research group
Nov 28, 2002·Journal of Clinical Psychopharmacology·Mark ZimmermanIwona Chelminski
Dec 19, 2002·Biological Psychiatry·Stephen M StahlRichard L Rudolph
Jun 5, 2003·The Australian and New Zealand Journal of Psychiatry·Roger T MulderRichard Porter
Jun 7, 2003·Psychotherapy and Psychosomatics·Nigel McKenzie, Isaac Marks
Jun 1, 1961·Archives of General Psychiatry·A T BECKJ ERBAUGH
Sep 25, 2003·JAMA : the Journal of the American Medical Association·Sean R TunisCarolyn M Clancy
Mar 9, 2004·The Journal of Clinical Psychiatry·Mark ZimmermanIwona Chelminski
Jan 5, 2006·The American Journal of Psychiatry·Madhukar H TrivediUNKNOWN STAR*D Study Team
Jun 14, 2006·European Neuropsychopharmacology : the Journal of the European College of Neuropsychopharmacology·Thomas J CarmodyMadhukar H Trivedi
Dec 30, 2006·European Psychiatry : the Journal of the Association of European Psychiatrists·Saskia M de MaatFrans de Jonghe
May 2, 2007·Journal of Consulting and Clinical Psychology·Takuya MinamiGeorge S Jeb Brown
Dec 20, 2007·International Clinical Psychopharmacology·Koen DemyttenaereSangeleer Michèle
Jul 11, 2008·Australasian Psychiatry : Bulletin of Royal Australian and New Zealand College of Psychiatrists·Roderick McKay, Regina McDonald
Jul 16, 2008·The British Journal of Clinical Psychology·Michael BarkhamLynne Angus
Oct 15, 2008·Journal of Affective Disorders·Carla Moleiro, Larry E Beutler
Apr 3, 2009·The American Journal of Psychiatry·Stephen R WisniewskiMadhukar H Trivedi
Jul 10, 2010·Psychotherapy and Psychosomatics·H Edmund PigottJohn J Boren
Jan 1, 1998·International Journal of Psychiatry in Clinical Practice·C J HawleyP Sen

❮ Previous
Next ❯

Citations

Jun 28, 2014·Journal of Substance Abuse Treatment·Elisabeth A de GeeGerard M Schippers
Sep 17, 2013·International Journal of Methods in Psychiatric Research·Florian NaudetBruno Falissard
Nov 20, 2014·Depression and Anxiety·Roy H Perlis
Feb 17, 2015·The British Journal of Dermatology·J van der SchaftM S de Bruin-Weller
Mar 13, 2015·Journal of Telemedicine and Telecare·Anne-Kirstine DyrvigHindrik Vondeling
Feb 17, 2017·Epidemiology and Psychiatric Sciences·M Kösters
Oct 30, 2016·Epidemiology and Psychiatric Sciences·P CuijpersJ Twisk
Dec 5, 2017·Psychotherapy Research : Journal of the Society for Psychotherapy Research·M Annet NugterFabiana Engelsbel
Apr 25, 2014·International Psychogeriatrics·Marjolein A VeerbeekAnne Margriet Pot
Nov 30, 2019·Psychological Medicine·Johan OrmelSteven D Hollon
Aug 18, 2018·Irish Journal of Psychological Medicine·D AherneN Whelan

❮ Previous
Next ❯

Related Concepts

Related Feeds

Bipolar Disorder

Bipolar disorder is characterized by manic and/or depressive episodes and associated with uncommon shifts in mood, activity levels, and energy. Discover the latest research this illness here.

Anxiety Disorders

Discover the latest research on anxiety disorders including agoraphobia, panic disorder, obsessive-compulsive disorder, and post-traumatic stress disorder here.

Related Papers

The International Journal of Neuropsychopharmacology
Diane WardenMadhukar H Trivedi
JAMA : the Journal of the American Medical Association
Brett D ThombsRoy C Ziegelstein
© 2021 Meta ULC. All rights reserved