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We performed an umbrella review of recent meta\u2010analyses of randomized controlled trials (RCTs) of psychotherapies and pharmacotherapies for the main mental disorders in adults. We selected meta\u2010analyses that formally assessed risk of bias or quality of studies, excluded weak comparators, and used effect sizes for target symptoms as primary outcome. We searched PubMed and PsycINFO and individual records of the Cochrane Library for meta\u2010analyses published between January 2014 and March 2021 comparing psychotherapies or pharmacotherapies with placebo or treatment\u2010as\u2010usual (TAU), or psychotherapies vs. pharmacotherapies head\u2010to\u2010head, or the combination of psychotherapy with pharmacotherapy to either monotherapy. One hundred and two meta\u2010analyses, encompassing 3,782 RCTs and 650,514 patients, were included, covering depressive disorders, anxiety disorders, post\u2010traumatic stress disorder, obsessive\u2010compulsive disorder, somatoform disorders, eating disorders, attention\u2010deficit\/hyperactivity disorder, substance use disorders, insomnia, schizophrenia spectrum disorders, and bipolar disorder. Across disorders and treatments, the majority of effect sizes for target symptoms were small. A random effect meta\u2010analytic evaluation of the effect sizes reported by the largest meta\u2010analyses per disorder yielded a standardized mean difference (SMD) of 0.34 (95% CI: 0.26\u20100.42) for psychotherapies and 0.36 (95% CI: 0.32\u20100.41) for pharmacotherapies compared with placebo or TAU. The SMD for head\u2010to\u2010head comparisons of psychotherapies vs. pharmacotherapies was 0.11 (95% CI: \u20130.05 to 0.26). The SMD for the combined treatment compared with either monotherapy was 0.31 (95% CI: 0.19\u20100.44). Risk of bias was often high. After more than half a century of research, thousands of RCTs and millions of invested funds, the effect sizes of psychotherapies and pharmacotherapies for mental disorders are limited, suggesting a ceiling effect for treatment research as presently conducted. A paradigm shift in research seems to be required to achieve further progress.<\/jats:p>","DOI":"10.1002\/wps.20941","type":"journal-article","created":{"date-parts":[[2022,1,11]],"date-time":"2022-01-11T11:12:18Z","timestamp":1641899538000},"page":"133-145","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":476,"title":["The efficacy of psychotherapies and pharmacotherapies for mental disorders in adults: an umbrella review and meta\u2010analytic evaluation of recent meta\u2010analyses"],"prefix":"10.1002","volume":"21","author":[{"given":"Falk","family":"Leichsenring","sequence":"first","affiliation":[{"name":"Department of Psychosomatics and Psychotherapy University of Giessen Giessen Germany"},{"name":"Department of Psychosomatics and Psychotherapy University of Rostock Rostock 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