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Psychological treatments reduce symptoms in the short term in adults with depression identified in primary care

Linde K, Sigterman K, Kriston L, et al. Effectiveness of psychological treatments for depressive disorders in primary care: systematic review and meta-analysis. Ann Fam Med. 2015;13:56-68.

Review questions

In adults with unipolar depression (not bipolar or manic–depressive disorder) who are referred by, or screened in, primary care (e.g., by family doctors or other health care workers providing general health care), do psychological treatments reduce symptoms more than placebo or usual care?

Background

Depression is a common mood disorder that affects how you feel, think, and behave. Symptoms of depression (e.g., feeling sad, losing interest in things you like to do, having trouble thinking or concentrating, feeling anxious or restless) can be mild or more severe and persistent (major depression).

Depression is more than just being sad and may get worse if not treated. Psychological treatments for depression may help to reduce symptoms by helping you change how you think or feel about things and how you behave with others.

How the review was done

The researchers did a systematic review, searching for studies that were published up to December 2013.

They found 30 randomized controlled trials with 5,159 people (average age 30 to 81 years, 41% to 100% women).

The key features of the trials were:

  • people had depressive disorders and were referred from, or screened in, primary care settings;
  • treatments were cognitive-behavioural therapy, which helps you change inaccurate or negative patterns of thinking and how you behave in difficult situations; problem-solving therapy, which helps you identify problems that may affect how you feel and find solutions to them; interpersonal therapy, which focuses on relationship issues and helps you change how you interact with others ; and other psychological treatments (e.g., psychological education or counselling);
  • most treatments were done face-to-face with a therapist, some were done by telephone or computer contact with a therapist (remote therapist-led therapy), and some were done using books or computer programs with some contact with a therapist (guided therapy) or little or no contact with a therapist;
  • most treatments were compared with usual care; and
  • most people were treated for 6 to 16 weeks.

What the researchers found

Compared with control:

  • psychological treatment reduced depressive symptoms in the short term; and
  • cognitive-behavioural therapy reduced depressive symptoms in the short term, whether it was done face-to-face, by telephone or computer contact with a therapist, or with little contact with a therapist.

Not enough information was found about the effects of psychological treatment for more than 16 weeks.

Conclusion

In adults with depression identified in primary care, psychological treatments reduce symptoms more than usual care in the short term.

Psychological treatments vs control* for reducing symptoms in people with depression in primary care

Psychological treatment†

Number of trials

Absolute effect of treatment on depressive symptoms‡

Any psychological treatment

27 trials

Improvement in depression scores in about 10 more people out of 100 (from as few as 8 to as many as 13)

Cognitive-behavioural therapy done face-to-face

7 trials

Improvement in depression scores in about 10 more people out of 100 (from as few as 3 to as many as 20)

Problem-solving therapy done face-to-face

3 trials

No difference in effect

Interpersonal therapy done face-to-face

2 trials

No difference in effect

Other psychological therapies done face-to-face§

6 trials

Improvement in depression scores in about 10 more people out of 100 (from as few as 4 to as many as 17)

Remote therapist-led cognitive-behavioural therapy

3 trials

Improvement in depression scores in about 17 more people out of 100 (from as few as 8 to as many as 25)

Guided self-help cognitive-behavioural therapy

4 trials

Improvement in depression scores in about 12 more people out of 100 (from as few as 5 to as many as 20)

No/minimal contact cognitive-behavioural therapy

4 trials

Improvement in depression scores in about 10 more people out of 100 (from as few as 2 to as many as 17)

*Usual care, placebo, counselling, or no treatment.

†Treatments were done face-to-face with a therapist; by telephone or computer contact with a therapist (remote therapist-led therapy); or using books or computer programs, with little or no contact with a therapist.

‡Score on a depression scale reduced by 50% or more.

§Counselling or psychological education.




Glossary

Placebo
A harmless, inactive, and simulated treatment.
Randomized controlled trials
Studies where people are assigned to one of the treatments purely by chance.
Systematic review
A comprehensive evaluation of the available research evidence on a particular topic.

Related Evidence Summaries

Related Web Resources

  • Depression

    Informed Health Online
    Depression is a common mood disorder that can make it hard to cope with everyday life. Causes and risk factors for depression include genes, difficult experiences and life circumstances, chronic anxiety disorders, biochemical changes, medical problems, and lack of light. Psychological therapies (e.g., cognitive behavioral therapy) and medication, alone or combination, are treatment options.
  • Medicines for Treating Depression: A Review of the Research for Adults

    OHRI
    This patient decision aid helps adults diagnosed as being depressed decide on the type of medicine by comparing the benefits, risks and side effects of each antidepressant.
  • Patient education: Delirium (Beyond the Basics)

    UpToDate - patient information
    Delirium is the result of brain changes that lead to confusion, lack of focus and memory problems. There is no specific treatment for delirium - it is best to avoid risks, treat underlying illnesses and receive supportive care. Sedatives and physical restraints should be avoided.
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