Treatment for Depression Among Adults: An Evidence and Gap Map of Systematic Reviews

To identify and map systematic reviews on the effectiveness of treatment for depressive disorders among adults.

We retrieved systematic reviews and meta-analyses of randomized controlled trials involving adults with depressive symptoms from twelve English and four Chinese databases (June 21, 2022). Using an interactive map, we visualized the effectiveness of evidence on depression based on an intervention-outcome framework. The interventions included psychotherapy, pharmacotherapy, complementary and alternative treatments, and others. The outcomes included the remission of depressive symptoms, symptoms of depressive disorder, life and social skills, and adverse events.

We included 994 systematic reviews and meta-analyses, including 32 that were review protocols, highlighting the distribution of psychotherapy, pharmacotherapy, and complementary and alternative treatments. However, the evidence and gap map (EGM) revealed significant gaps in evidence for specific interventions, populations, outcomes, and regions. While psychotherapy, pharmacotherapy, and complementary and alternative treatments dominate the landscape, the review highlighted a lack of research on interventions for specific types of depression, such as depression in people with bipolar disorder and treatment-resistant depression. It was a similar situation for underserved populations, including young and middle-aged adults, males, sexual minority individuals, and people with disabilities. The map also suggested the need for more research on the potential risks and side effects associated with both pharmacological and nonpharmacological treatments.

The contribution of this EGM was to present the available evidence on psychotherapy, pharmacotherapy, and complementary and alternative treatments for depression in adults, making available an evidence base that could inform future policy decisions and practice. It also identified evidence gaps in interventions, outcomes, population, regions, and evidence confidence. The need for further research on tailored treatments for specific populations was highlighted.