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Psychotherapy, Antidepressants, and Combined Treatment for Depression: A Network Meta-Analysis on Social Functioning
Clara Miguel1, Lingyao Tong2, Aran Tajika3
1Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands, clara.miguel.snz@gmail.com.
Psychotherapy and Psychosomatics
|June 24, 2026
Summary
First-line depression treatments improve social functioning, with combined therapy showing the largest effects. More trials are needed to assess patient-valued outcomes like social participation.
Area of Science:
- Psychiatry and Mental Health
- Clinical Psychology
- Evidence-Based Medicine
Background:
- Social functioning is crucial for depression recovery, but research often prioritizes symptom reduction.
- Comparative data on social functioning for first-line depression treatments is limited.
Purpose of the Study:
- To compare the effects of psychotherapy, antidepressant medication, and their combination on social functioning in adults with major depression.
Main Methods:
- Systematic review and network meta-analysis of randomized controlled trials (RCTs) up to May 2025.
- Included 94 trials (23,874 participants) assessing social functioning outcomes.
- Calculated standardized mean differences (SMD) at post-treatment and follow-up, assessing evidence certainty with CINeMA.
Main Results:
- All active treatments outperformed control conditions in improving social functioning.
- Combined psychotherapy and pharmacotherapy demonstrated the largest effects versus placebo (SMD 0.75 post-treatment, 1.08 follow-up).
- Psychotherapy and pharmacotherapy showed comparable effects, with moderate to low certainty of evidence.
Conclusions:
- First-line depression treatments positively impact social functioning and daily life participation.
- Only 19% of trials assessed social functioning, indicating a need for greater focus on patient-valued outcomes in future research.
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