Welke psychologische behandeling, uitgevoerd door wie, is het meest effectief bij depressie?
Samenvatting
Meta-analytisch onderzoek kan geen antwoord geven op de vraag "welke behandeling, uitgevoerd door wie, is het meest effectief bij deze patiënt". Dit type onderzoek kan echter wel belangrijke deelvragen daarvan beantwoorden, zoals welke therapieën effectief zijn, of de uitkomsten samenhangen met de behandelaar en de samenhang tussen kenmerken van de patiënt en de effecten. In dit artikel beschrijven we een meta-analytische database van 188 studies naar psychotherapie bij depressie en we vatten de belangrijkste resultaten ervan samen, evenals de resultaten van de ruim 20 papers die we over deze database publiceerden. Ook vergelijken we de uitkomsten daarvan met de resultaten van 42 andere meta-analyses over dit onderwerp. De resultaten laten zien dat verschillende vormen van psychotherapie effectief zijn en dat de verschillen tussen therapieën klein tot afwezig zijn. De effecten van psychotherapie zijn vergelijkbaar met die van farmacotherapie, behalve bij dysthymie patiënten (daarbij is farmacotherapie effectiever). Gecombineerde behandeling is effectiever dan psychotherapie alleen of farmacotherapie alleen. Het is goed mogelijk dat we de effecten van psychotherapie aanzienlijk overschatten doordat studies met lage kwaliteit grotere effecten laten zien dan studies met hoge kwaliteit en omdat we waarschijnlijk ook te maken hebben met het verschijnsel ‘publicatiebias'. Psychotherapie is ook effectief bij ouderen, bij postpartum depressie, bij patiënten met een lichamelijke aandoening, bij chronische depressies (hoewel de effecten daar klein zijn) en bij subklinische depressies. Er zijn geen aanwijzingen dat psychotherapie minder effectief is bij ernstige depressies. Toekomstig onderzoek zal zich moeten richten op effectmoderatoren en -mediatoren, en op andere onderwerpen zoals voorkeuren van patiënten, kosteneffectiviteit en disseminatie van evidence-based behandelingen.
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