Psychotherapies for depression: a network meta-analysis covering efficacy, acceptability and long-term outcomes of all main treatment type

Abstract

The efects of psychotherapies for depression have been examined in several hundreds of randomized trials, but no recent network meta-analysis (NMA) has integrated the results of these studies. We conducted an NMA of trials comparing cognitive behavioural, interpersonal, psychodynamic, problem-solving, behavioural activation, life-review and “third wave” therapies and non-directive supportive counseling with each other and with care-as-usual, waiting list and pill placebo control conditions. Response (50% reduction in symptoms) was the primary outcome, but we also assessed remission, standardized mean dierence, and acceptability (all-cause dropout rate). Random-eects pairwise and network meta-analyses were conducted on 331 randomized trials with 34,285 patients. All therapies were more ecacious than care-as-usual and waiting list control conditions, and all therapies – except non-directive supportive counseling and psychodynamic therapy – were more ecacious than pill placebo. Standardized mean dierences compared with care-as-usual ranged from –0.81 for life-review therapy to –0.32 for non-directive sup-portive counseling. Individual psychotherapies did not dier signicantly from each other, with the only exception of non-directive supportive counseling, which was less ecacious than all other therapies. e results were similar when only studies with low risk of bias were included. Most therapies still had signicant eects at 12-month follow-up compared to care-as-usual, and problem-solving therapy was found to have a somewhat higher long-term ecacy than some other therapies. No consistent dierences in acceptability were found. Our conclusion is that the most important types of psychotherapy are ecacious and acceptable in the acute treatment of adult depression, with few signicant dierences between them. Patient preference and availability of each treatment type may play a larger role in the choice between types of psychotherapy, although it is possible that a more detailed characterization of patients with a diagnosis of depression may lead to a more precise matching between individual patients and individual psychotherapies