“Why should we require better ‘number needed to treat’ statistics from psychological than from pharmacological treatments?”

Reading the title of the study by Noble et al 1 in Journal of Neurology, Neurosurgery and Psychiatry, ‘Cognitive-behavioural therapy does not meaningfully reduce depression in most people with epilepsy: a systematic review with a reliable change analysis’, stakeholders in ‘Psychotherapy Incorporated’ may wonder whether they need to rush to their stockbroker and sell their cognitive-behavioural therapy (CBT) shares. They need not hurry—but they will need to read the whole paper or this comment.

The pooled findings of the meta-analysis by Noble et al of five randomised controlled studies in which at least some elements of CBT were used to treat depression or anxiety in patients with epilepsy demonstrate that the chances of reliable improvement according …