Depression in adults: psychological treatments and care pathways

Depression may affect up to 10% of the population, with symptoms recurring in half of affected people. In mild to moderate depression, there is no reliable evidence that any one treatment is superior in improving symptoms of depression, but the strength of evidence supporting different treatments varies.

We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of psychological treatments, and of interventions to reduce relapse rates, in mild to moderate or severe depression? What are the effects of psychological interventions to improve delivery of treatments in mild to moderate or severe depression? We searched: Medline, Embase, The Cochrane Library and other important databases up to April 2006 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).

We found 55 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.

In this systematic review we present information relating to the effectiveness and safety of the following interventions: befriending, care pathways, cognitive therapy, combining antidepressant drugs and psychological treatments, interpersonal psychotherapy, non-directive counselling, problem-solving therapy, relapse prevention programme.