A systematic review and network meta-analysis of psychological, psychosocial, pharmacological, physical and combined treatments for adults with a new episode of depression.
Level 1 - systematic review of randomized trials
Systematic review and network meta-analysis of randomised controlled trials
PubMed 39246718 · doi:10.1016/j.eclinm.2024.102780
What was done
Systematic review and network meta-analysis of randomised controlled trials published up to June 2020 and updated in November 2023 to identify effective first-line treatments for adults with a new episode of less severe or more severe depression (defined by scale cut-offs). The primary efficacy outcome was depressive symptom change measured as standardised mean difference (SMD) across 63 treatment classes.
What was found
The review included 676 RCTs and 105,477 participants. For less severe depression versus treatment as usual, group cognitive/cognitive behavioural therapy (CT/CBT) was efficacious (SMD -1.01, 95% CrI -1.76 to -0.06), with group yoga and unguided self-help also emerging as efficacious in the update, while antidepressants showed no evidence of effect. For more severe depression versus pill placebo, efficacious classes included combined individual CT/CBT with antidepressants (SMD -1.18, 95% CrI -2.07 to -0.44), individual behavioural therapies (SMD -0.86, 95% CrI -1.65 to -0.16), combined light therapy with antidepressants (SMD -0.86, 95% CrI -1.59 to -0.12), combined acupuncture with antidepressants (SMD -0.78, 95% CrI -1.12 to -0.44), individual CT/CBT (SMD -0.78, 95% CrI -1.42 to -0.33), mirtazapine (SMD -0.35, 95% CrI -0.48 to -0.22), SNRIs (SMD -0.32, 95% CrI -0.43 to -0.22), tricyclics (SMD -0.29, 95% CrI -0.50 to -0.05), and SSRIs (SMD -0.24, 95% CrI -0.32 to -0.16). In the 2023 update, combined group exercise with antidepressants showed efficacy, while combined light therapy did not.
Why it matters
This large network meta-analysis informed updated NICE guidelines, showing that psychological interventions are efficacious without antidepressants for less severe depression, while combination therapies and individual treatments remain effective for more severe depression.
Limits
The evidence quality was rated low for less severe depression and low-to-moderate for more severe depression. Wide credible intervals indicate imprecision in several treatment class estimates, and the abstract does not report long-term outcomes, acceptability, or adverse effects.
Cited by
- supports Cognitive behavioral therapy is considered a gold standard and first-line treatment for depression.