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Evid Based Med. 2016 Dec;21(6):214-221. doi: 10.1136/ebmed-2016-110522. Epub 2016 Nov 11.

Non-pharmacological treatment of depression: a systematic review and evidence map.

Author information

1
Evidence-Based Practice Center, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA.
2
Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA.
3
Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, Minnesota, USA.
4
Division of Integrated Behavioral Health, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA.
5
Mayo Graduate School, Mayo Clinic, Rochester, Minnesota, USA.
6
Center for Pharmacy Innovation and Outcomes, Geisinger Health System, Forty Fort, Pennsylvania, USA.
7
Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA.
8
Mayo Clinic Libraries, Mayo Clinic, Rochester, Pennsylvania, USA.

Abstract

BACKGROUND:

The comparative effectiveness of non-pharmacological treatments of depression remains unclear.

METHODS:

We conducted an overview of systematic reviews to identify randomised controlled trials (RCTs) that compared the efficacy and adverse effects of non-pharmacological treatments of depression. We searched multiple electronic databases through February 2016 without language restrictions. Pairs of reviewers determined eligibility, extracted data and assessed risk of bias. Meta-analyses were conducted when appropriate.

RESULT:

We included 367 RCTs enrolling ∼20 000 patients treated with 11 treatments leading to 17 unique head-to-head comparisons. Cognitive behavioural therapy, naturopathic therapy, biological interventions and physical activity interventions reduced depression severity as measured using standardised scales. However, the relative efficacy among these non-pharmacological interventions was lacking. The effect of these interventions on clinical response and remission was unclear. Adverse events were lower than antidepressants.

LIMITATION:

The quality of evidence was low to moderate due to inconsistency and unclear or high risk of bias, limiting our confidence in findings.

CONCLUSIONS:

Non-pharmacological therapies of depression reduce depression symptoms and should be considered along with antidepressant therapy for the treatment of mild-to-severe depression. A shared decision-making approach is needed to choose between non-pharmacological therapies based on values, preferences, clinical and social context.

PMID:
27836921
DOI:
10.1136/ebmed-2016-110522
[Indexed for MEDLINE]

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