Evidence map›Paper›PMID 41563926›Full record

SynthesisPsychotherapy and psychosomatics2026

Modifiers in Effects of Combined Pharmacotherapy and Psychotherapy versus Pharmacotherapy Alone for Adult Depression: An Individual Participant Data Meta-Analysis.

Marketa Ciharova, Eirini Karyotaki, Mathias Harrer, Erica Weitz, Clara Miguel, Arpana Amarnath, Toshi A Furukawa, Constantin Yves Plessen, Ellen Driessen, Claudia Buntrock and 40 more

Abstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Psychotherapy and psychosomatics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

50 authors.

Marketa CiharovaDepartment of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands, m.ciharova@vu.nl.
Eirini KaryotakiDepartment of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
Mathias HarrerDepartment of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
Erica WeitzCenter for the Treatment and Study of Anxiety, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Clara MiguelDepartment of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
Arpana AmarnathDepartment of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
Toshi A FurukawaDepartment of Health Promotion and Human Behavior, School of Public Health, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Constantin Yves PlessenDepartment of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
Ellen DriessenDepartment of Clinical Psychology, Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands.
Claudia BuntrockInstitute of Social Medicine and Health Systems Research, Medical Faculty, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany.
Lingyao TongDepartment of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
David HellersteinDepartment of Psychiatry, Columbia University, New York, New York, USA.
Lisa W SamstagDepartment of Psychology, Long Island University, New York, New York, USA.
Ying ChenDepartment of Psychiatry, Columbia University, New York, New York, USA.
Sreevani RentalaDepartment of Psychiatric Nursing, Dharwad Institute of Mental Health and Neurosciences, Dharwad, India.
Curt HemannyPrograma de Pós-Graduação em Medicina e Saúde, Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Brazil.
Irismar Reis de OliveiraDepartamento de Neurociências e Saúde Mental, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil.
Marc B J BlomParnassia Psychiatric Institute, The Hague, The Netherlands.
Yvonne BurnandGeneva University Hospital Center, Geneva, Switzerland.
Antonio AndreoliGeneva University Hospital Center, Geneva, Switzerland.
Andrea K WittenbornDepartment of Human Development and Family Studies, Michigan State University, East Lansing, Michigan, USA.
Kevin L DelucchiDepartment of Psychiatry, University of California, San Francisco, California, USA.
Nusrat HusainDivision of Psychology & Mental Health, University of Manchester, Manchester, UK.
Robert J DeRubeisDepartment of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Joel M TownDepartment of Psychiatry, Centre for Emotions and Health, Dalhousie University, Halifax, Nova Scotia, Canada.
Frank RöhrichtCentre for Psychiatry and Mental Health Wolfson Institute, Queen Mary University of London, FRCPsych, Consultant Psychiatrist East London NHS Foundation Trust, London, UK.
Han ChoiLocal Multicultural Education Research Center, Sun Moon University, Asan City, Republic of Korea.
Jack DekkerMentrum Mental Health Amsterdam, Department SPDC, Amsterdam, The Netherlands.
David J A DozoisDepartment of Psychology, University of Western Ontario, London, Ontario, Canada.
Martin B KellerDepartment of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, USA.
Raymond W LamDepartment of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
François LespéranceDepartment of Psychiatry and Addiction, Université de Montreal, Montreal, Québec, Canada.
Giuseppe MainaDepartment of Neurosciences, San Luigi Gonzaga University Hospital, DUniversity of Turin, Turin, Italy.
Gianluca RossoDepartment of Neurosciences, San Luigi Gonzaga University Hospital, DUniversity of Turin, Turin, Italy.
Jeanette MilgromParent-Infant Research Institute, Austin Health, Heidelberg, Victoria, Australia.
Arun RavindranDepartments of Psychiatry & Pharmacology and Toxicology, Institute of Medical Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Charles F Reynolds IiiSchool of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Nicola WilesCentre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
Brandon A GaudianoDepartment of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, USA.
Livia Hartmann de SouzaMood Disorders Outpatient Program, PROTHUM, Federal University of Rio Grande do Sul, UFRGS/Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
Atsuo NakagawaDepartment of Neuropsychiatry, St. Marianna University School of Medicine, Kawasaki, Japan.
Beatriz Rodríguez VegaUniversity Hospital La Paz, Autonomous University of Madrid, Madrid, Spain.
Angela PalaoUniversity Hospital La Paz, Autonomous University of Madrid, Madrid, Spain.
Jaime López RodríguezNational Institute of Psychiatry, Mexico City, Mexico.
Valerio Villamil SalcedoNational Institute of Psychiatry, Mexico City, Mexico.
Ingo ZobelPsychology School, Hochschule Fresenius, University of Applied Sciences Berlin, Berlin, Germany.
Elisabeth SchrammDepartment of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Steven D HollonDepartment of Psychology, Vanderbilt University, Nashville, Tennessee, USA.
Heleen RiperDepartment of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
Pim CuijpersDepartment of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionIt is not clear which individual-patient- and study-level variables modify the effects in the comparison of combined treatment versus pharmacotherapy alone for adult depression.

methodsRandomized trials comparing combined treatment with pharmacotherapy alone were identified on September 1, 2024, and individual participant data (IPD) requested from the authors. One-stage IPD meta-analyses were conducted to estimate effects on depressive symptoms at posttreatment and follow-up, response, remission, and reliable improvement and to assess effect modifiers.

resultsOf 75 eligible studies, 31 (41.33%) provided their IPD (3,703 participants). Combined treatment was more effective in reducing depressive symptoms at posttreatment (SMD = 0.45, 95% confidence interval [95% CI]: 0.27-0.64), 6- (SMD = 0.55, 95% CI: 0.25-0.85) and 12-month follow-up (SMD = 0.22, 95% CI: 0.02-0.43). The effect size was smaller in studies that provided IPD than in those that did not. No patient-level effect modifiers were identified. No difference between the two arms was found in studies using SSRIs (as opposed to other antidepressants) and recruiting specific target groups (versus unselected adult populations), and the difference between combined treatment and pharmacotherapy alone was larger if pharmacotherapy was not administered adequately, but these findings were not confirmed in sensitivity analyses. Several patient-level characteristics predicted higher depressive symptoms at posttreatment, regardless of treatment condition.

conclusionCombined treatment outperforms pharmacotherapy alone regardless of individual characteristics. Thus, its delivery does not have to be limited to specific patient subgroups. However, IPD were available for only 41% of eligible studies, thus limiting this sample's representativeness.

Indexed as

Combined treatmentDepressionIndividual participant data meta-analysisPharmacotherapyPsychotherapy

Identifiers

PMID41563926
PMCPMC13004618

What OpenQuestion holds

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.