Discussion
The novel contributions of our review are twofold. First,
our focus was on remission instead of effect size (11–13) or
response (10). The finding that there were significantly
more patients in the Elkin et al. study (22) who responded
to treatment than achieved full remission lends support to
the hypothesis that some “responders” may still have a
substantial degree of residual depressive symptoms,
thereby confirming that the focus on full remission represents
an important paradigm shift in the field. Second, to
our knowledge, this is the first review that examines the
comparative efficacy of pharmacotherapy and psychotherapy
for major depressive disorder exclusively on the
basis of the results of multiple-cell randomized, controlled
trials that directly compared medications, psychotherapies,
and control conditions. This approach, as suggested
by others (14), is the only safeguard against noncomparability
of study groups, inadequate implementation of
pharmacotherapy, and nonspecific treatment effects. We
also examined a more homogenously defined patient
group than was covered in other meta-analyses (11–13),