A systematic review and network meta-analysis of psychological, psychosocial, pharmacological, physical and combined treatments for adults with a new episode of depression
Abstract
Summary Background Various effective treatments for depression exist. We aimed to identify the most effective first-line treatments for new episodes of less and more severe depression (defined by depression scale cut-off scores), to update NICE guidance on the management of Depression in Adults in England. Methods Systematic review and network meta-analysis of randomised controlled trials (RCTs) published up to June 2020 (PROSPERO registration number CRD42019151328). We analysed interventions by class and individually. The primary efficacy outcome was depressive symptom change (expressed as standardised mean difference [SMD]). The review for this outcome was updated in November 2023. Findings We included 676 RCTs, 105,477 participants and 63 treatment classes. For less severe depression, group cognitive/cognitive behavioural therapy (CT/CBT) class was efficacious versus treatment as usual [TAU], the reference treatment for this population [SMD −1.01 (95% Credible Interval [CrI] −1.76; −0.06)]. For more severe depression, efficacious classes versus pill placebo (reference treatment for this population) included combined individual CT/CBT with antidepressants [−1.18 (−2.07; −0.44)], individual behavioural therapies [−0.86 (−1.65; −0.16)], combined light therapy with antidepressants [−0.86 (−1.59; −0.12)], combined acupuncture with antidepressants [−0.78 (−1.12; −0.44)], individual CT/CBT [−0.78 (−1.42; −0.33)], mirtazapine [−0.35 (−0.48; −0.22)], serotonin and norepinephrine…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 105,477 participants or records.
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