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, 05/16/2012

Effectiveness of treatment for mild–to–moderate major depressive disorder in daily practice is similar to STAR*D and significantly lower than efficacy results from randomized controlled trials.


  • 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 vs. 1.71) and combination therapy (21 vs. 45-63%), since only 60% of the meta-analyses for antidepressants showed significant differences with ROM, while for psychotherapy and combination treatment almost all meta-analyses showed significant differences.
  • No differences in effectiveness were found between routine practice and STAR*D (antidepressants 27 vs. 28%; individual psychotherapy 27 vs. 25%; combination treatment 21 vs. 23%, respectively).

Print Article Summary Cat 2 CME Report