Medication vs therapy: the new meta-analysis

Okay this Lancet meta-analysis just dropped and it's a big one. 47 RCTs comparing medication vs CBT vs combined treatment for adult ADHD.

I've been waiting for this. The effect sizes for combined treatment have to be significant, right? That's what we're all seeing clinically.

Combined wins, but the interesting part is WHERE it wins. Medication dominates on core symptom reduction. CBT dominates on functional outcomes — relationships, work performance, self-esteem.

This matches what I see in my patients. Stimulants help you focus. Therapy helps you figure out what to focus on.

The dropout rates tell a story too. Medication-only arms had 34% dropout. CBT-only had 28%. Combined? 19%. People stick with treatment when it works on multiple levels.

The real headline for me is that the effect sizes for CBT alone have improved dramatically compared to the 2015 Cochrane review. The therapy is getting better.

Probably because the newer CBT protocols are ADHD-specific rather than adapted from depression/anxiety frameworks. Turns out treating ADHD like ADHD works better. Revolutionary concept.

I'm already sending this to three patients who've been on the fence about adding therapy. Hard data helps.