[Psychological treatment of depression; a systematic review of meta-analyses]

Abstract

Objective: To provide a review of the meta-analyses of the efficacy of psychological treatment of patients with a depressive disorder.

Design: Systematic review.

Method: A search was performed in Pubmed, Psycinfo and DARE, in earlier reviews and in the lists of references of recovered articles. The inclusion criteria were: statistical meta-analyses of randomised studies that had been published in English in the period 2000-2004. 3 types of outcome measures were distinguished: effects on recovery, effects on the severity of the depressive symptoms, and dropping out.

Results: 10 meta-analyses were included with a total of 132 primary studies, of which 25 (19%) appeared in more than one meta-analysis. Psychological interventions in general appeared to have a significant effect on recovery (oddsratio: 3.01) and on the reduction of the depressive symptoms (standardized effect size: -0.90). Cognitive behaviour therapy had been especially thoroughly investigated; there was no convincing evidence that this type of therapy was more effective than other psychological treatments. Minimal psychological interventions also had major effects. Psychological treatment was also effective in children and adolescents. Treatment with antidepressants alone was less effective than combined therapy with antidepressants and psychological intervention. There were no indications that the drop-out rate during psychotherapy was different from that in controls.

Conclusion: There is much empirical support for the efficacy of psychological treatment of patients with depressive disorders.