Psychological treatment of depression: Results of a series of meta-analyses

Department of Clinical Psychology, VU University Amsterdam, and EMGO Institute, The Netherlands.
Nordic journal of psychiatry (Impact Factor: 1.34). 07/2011; 65(6):354-64. DOI: 10.3109/08039488.2011.596570
Source: PubMed


In the past few decades, a considerable number of studies have examined the effects of psychotherapies for adult depression.
We described the results of a series of meta-analyses examining what this large body of research has contributed to our knowledge of these treatments of depression.
We found that different types of psychotherapy are efficacious in the treatment of adult depression, including cognitive behavior therapy, interpersonal psychotherapy, problem-solving therapy, non-directive supportive therapy and behavioral activation therapy. Differences between types of psychotherapy are small. The efficacy of psychotherapy for mild to moderate depression is about the same as the efficacy of pharmacotherapy, and that combined treatment is more effective than psychotherapy alone and pharmacotherapy alone. Psychotherapy is not only effective in depressed adults in general, but also in older adults, women with postpartum depression, patients with general medical disorders, in inpatients, in primary care patients, patients with chronic depression and in subthreshold depression.
We found no evidence showing that psychotherapy is less efficacious in severe depression (with mean baseline Hamilton Depression Rating Scale scores up to 31, mean Beck Depression Inventory scores up to 35.85 and mean Beck Depression Inventory-II scores up to 36.50), but effects are smaller in chronic depression. We also found that the effects of psychotherapy are probably overestimated because of publication bias and the relatively low quality of many studies in the field.

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Available from: Annemieke van Straten, Oct 29, 2014
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    • "These guidelines do not recommend antidepressant medication in patients with mild symptoms. With regard to psychoeducation, it has been demonstrated that it is an effective therapy in the treatment of depression in adults [9] [12], as it reduces depressive symptoms and can prevent depression in primary care patients [13] [14] [15]. It has also been proven to reduce depressive symptoms in mild and moderate depression in both the short term and long term [16] [17] [18] [19]. "
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    ABSTRACT: Background. There is evidence supporting the effectiveness of psychoeducation (PE) in patients with symptoms of depression in primary care (PC), but very few studies have assessed this intervention in antidepressant-na¨ıve patients. The aim of this study is to assess the effectiveness of a PE program in these patients, since the use of antidepressant (AD) medication may interfere with the effects of the intervention. Methods. 106 participants were included, 50 from the PE program (12 weekly 1.5-hour sessions) and 56 from the control group (CG) that received the usual care. Patients were assessed at baseline and at 3, 6, and 9 months. The main outcome measures were the Beck Depression Inventory (BDI) and remission based on the BDI. The analysis was carried out on an intention-to-treat basis. Results. The PE program group showed remission of symptoms of 40% (í µí±ƒ = 0.001) posttreatment and 42% (í µí±ƒ = 0.012) at 6 months. The analysis only showed significant differences in the BDI score posttreatment (í µí±ƒ = 0.008; effect size Cohen's í µí±‘ í® í° = 0.55). Conclusions. The PE intervention is an effective treatment in the depressive population not treated with AD medication. Before taking an AD, psychoeducational intervention should be considered.
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    • "This study has several features of developmental work research, and, at the same time, the ODS program was imported from the top down (Engeströ m, 2000). The ODS program was based on knowledge of a gap between supply and demand of psychiatric care, and the studies that usage of evidence-based practices with wide coverage may, to some degree, ameliorate this discrepancy (Cuijpers et al., 2011; Knekt et al., 2011). Owing to the motivation, planning, and coverage of the ODS program, the approach and design of education were decided at high levels of the organization through a top-down design. "
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    • "One challenge for the field will be who, or what agency, should take responsibility for such an effort. Although there do exist some notable efforts to bring together psychotherapy research results for the purposes of meta-analyses (Cuijpers, Anderson, Donker, & van Straten, 2011; Cuijpers et al., 2011), it is likely the case that no single research group, professional organization, or even a nationlevel system can take on the responsibility to accumulate such data-bases, since the efforts must be interprofessional and international in scope. It may be possible that web-based technology can be developed, perhaps sponsored by an international health organization, such as the World Health Organization or a consortium of international research agencies, to form a repository of evidencebased psychotherapies. "
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