What is the effectiveness of therapy?

From the Guidelines

Therapy is effective in treating various conditions, including depression and anxiety, with a combination of evidence-based approaches, such as cognitive-behavioral therapy (CBT) and medication, typically recommended for optimal results. The effectiveness of therapy varies widely depending on the specific condition being treated, the type of therapy used, and individual patient factors. For depression, second-generation antidepressants, such as SSRIs, are often prescribed, with the American College of Physicians recommending that clinicians select these medications based on adverse effect profiles, cost, and patient preferences 1. A standard course of therapy may involve 12-16 weekly sessions of 45-60 minutes each, though this can be adjusted based on progress.

Some key points to consider when evaluating the effectiveness of therapy include:

• The therapeutic alliance between patient and provider is crucial for success, as is patient engagement in the process, including completing between-session assignments 1.
• Regular assessment of progress using standardized measures helps determine when treatment goals have been met or if adjustments are needed.
• Most patients see meaningful improvement within 8-12 weeks of consistent participation, though some conditions may require longer treatment durations.
• The response rate to drug therapy may be as low as 50%, and clinicians should consider whether addition of other therapeutic modalities may be indicated if the response is not sufficient after adequate treatment 1.

In terms of specific medications, SSRIs like sertraline (50-200mg daily) or escitalopram (10-20mg daily) are commonly prescribed for depression and anxiety disorders. However, the evidence is insufficient to determine which patient factors can reliably predict response or nonresponse to an individual drug 1. Ultimately, the most effective therapy will depend on the individual patient's needs and circumstances, and a combination of evidence-based approaches, tailored to the patient's specific condition and preferences, is likely to yield the best results.

From the FDA Drug Label

The efficacy of Prozac was established in 5– and 6–week trials with depressed adult and geriatric outpatients (≥18 years of age) whose diagnoses corresponded most closely to the DSM–III (currently DSM–IV) category of major depressive disorder The efficacy of Prozac in children and adolescents was established in two 8– to 9–week placebo–controlled clinical trials in depressed outpatients whose diagnoses corresponded most closely to the DSM–III–R or DSM–IV category of major depressive disorder The efficacy of Prozac was established in 13–week trials with obsessive compulsive outpatients whose diagnoses corresponded most closely to the DSM–III–R category of OCD The efficacy of Prozac in children and adolescents was established in a 13–week, dose titration, clinical trial in patients with OCD, as defined in DSM–IV The efficacy of Prozac was established in 8– to 16–week trials for adult outpatients with moderate to severe bulimia nervosa, i.e., at least 3 bulimic episodes per week for 6 months The efficacy of Prozac 60 mg/day in maintaining a response, in patients with bulimia who responded during an 8–week acute treatment phase while taking Prozac 60 mg/day and were then observed for relapse during a period of up to 52 weeks, was demonstrated in a placebo–controlled trial

The effectiveness of therapy with fluoxetine is established in various clinical trials for:

• Major Depressive Disorder: 5- and 6-week trials in adults and geriatric outpatients, and 8- to 9-week trials in children and adolescents
• Obsessive Compulsive Disorder (OCD): 13-week trials in adults and a 13-week dose titration trial in children and adolescents
• Bulimia Nervosa: 8- to 16-week trials in adult outpatients, with maintenance of response demonstrated up to 52 weeks 2, 2, 2

From the Research

Effectiveness of Therapy

The effectiveness of therapy, particularly cognitive-behavioral therapy (CBT), has been extensively studied in various contexts and populations.

• CBT has been shown to be effective in treating acute depression, with various delivery formats such as individual, group, telephone-administered, guided self-help, and unguided self-help being compared in a network meta-analysis 3.
• The study found that individual, group, telephone, and guided self-help CBT were statistically significantly more effective than the waiting list and care as usual control conditions, as well as unguided self-help CBT.
• CBT has also been found to be effective in treating anxiety disorders, including posttraumatic stress disorder, obsessive-compulsive disorder, panic disorder, generalized anxiety disorder, social anxiety disorder, and specific phobia 4, 5.
• A meta-analytic review found that CBT was superior to psychodynamic therapy, although not interpersonal or supportive therapies, at post-treatment and at follow-up, particularly for patients with anxiety or depressive disorders 6.
• A panoramic meta-analysis of systematic reviews found that CBT produced a modest general, across-condition benefit in health-related quality-of-life, anxiety, and pain outcomes, with a statistically significant interaction effect between active and non-active comparator groups for the health-related quality-of-life outcome 7.

Delivery Formats and Populations

• Different delivery formats of CBT, such as individual, group, and guided self-help, have been found to be effective in various populations, including adults with depression and anxiety disorders 3, 5.
• The effectiveness of CBT has been found to be consistent across different age groups, delivery formats, and comparator types, although research on older adults, ethnic minorities, and people living outside Europe, North America, or Australasia is limited 7.
• CBT has been found to be effective in treating a variety of conditions, including depression, anxiety disorders, and pain, although the effect sizes are generally modest 7.

Limitations and Future Directions

• The quality of systematic reviews on CBT is often limited, with most reviews being of lower quality, and research on certain populations and conditions is limited 7.
• Future research should focus on increasing the effect sizes of CBT, identifying alternative delivery formats to increase adherence and reduce dropout, and pursuing novel methods to assess intervention fidelity and quality 7.