Initial treatment choices to achieve sustained response in major depression: a systematic review and network meta‐analysis

Abstract

Major depression is often a relapsing disorder. It is therefore important to start its treatment with therapies that maximize the chance of not only getting the patients well but also keeping them well. We examined the associations between initial treatments and sustained response by conducting a network meta-analysis of randomized controlled trials (RCTs) in which adult patients with major depression were randomized to acute treatment with a psychotherapy (PSY), a protocolized antidepressant pharmacotherapy (PHA), their combination (COM), standard treatment in primary or secondary care (STD), or pill placebo, and were then followed up through a maintenance phase. By design, acute phase treatment could be continued into the maintenance phase, switched to another treatment or followed by discretionary treatment. We included 81 RCTs, with 13,722 participants. Sustained response was defined as responding to the acute treatment and subsequently having no depressive relapse through the maintenance phase (mean duration: 42.2±16.2 weeks, range 24-104 weeks). We extracted the data reported at the time point closest to 12 months. COM resulted in more sustained response than PHA, both when these treatments were continued into the maintenance phase (OR=2.

Trends in the epidemiology of depression and comorbidities from 2000 to 2019 in Belgium

“…For less severe depression, medication should not be used, but psychotherapy should be offered. This approach is also supported by a recent meta-analysis [ 52 ].…”

Care pathways for people with major depressive disorder: A European Brain Council Value of Treatment study

“…We note here that by clinicians, we primarily refer to general physicians, although note that other healthcare professionals can also be involved in detecting depression and therefore our consideration of “detection” is not limited to medical doctors. Time to diagnosis/treatment: Missed diagnosis is closely linked with delays to both detection and treatment initiation for depression (and in some cases a delay to treatment after detection). After recognition/diagnosis (Step 1), treatments span the whole stepped care pathway (Steps 2–5). Rates of pharmacological/psychological treatment: As the mainstay interventions for MDD, it was considered important to include both pharmacological (antidepressants; Steps 3–5) and psychological therapies (Steps 2–5), which have more or less [25–27] equivalent efficacy. Rates and frequency of follow-up contacts after treatment: A key tenet of stepped-care approaches is ensuring continuity of care [28], and thus healthcare contacts are critical for monitoring treatment effects (including efficacy, tolerability, and adherence). …”

“…3. Rates of pharmacological/psychological treatment: As the mainstay interventions for MDD, it was considered important to include both pharmacological (antidepressants; Steps 3-5) and psychological therapies (Steps 2-5), which have more or less [25][26][27] equivalent efficacy. 4.…”

The Contribution of “Individual Participant Data” Meta-Analyses of Psychotherapies for Depression to the Development of Personalized Treatments: A Systematic Review

“…This large body of research suggests that all psychotherapies have comparable effects, although non-directive counseling may be somewhat less effective than other therapies [2]. This research has shown that the effects of psychotherapies are comparable to those of pharmacotherapy and that combined treatment is more effective than psychotherapy and pharmacotherapy alone [3], while in the longer term, combined treatment and psychotherapies are more effective than pharmacotherapy [4].…”