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

Wigdan H. Farah, Mouaz Alsawas, Maria Mainou, Fares Alahdab, Magdoleen H. Farah, Ahmed T. Ahmed, Essa A. Mohamed, Jehad Almasri, Michael R. Gionfriddo, Ana Castaneda-Guarderas, Khaled Mohammed, Zhen Wang, Noor Asi, Craig Sawchuk, Mark D Williams, Larry J. Prokop, Mohammad H Murad, Annie Leblanc

Research output: Contribution to journalReview article

18 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)214-221
Number of pages8
JournalEvidence-Based Medicine
Volume21
Issue number6
DOIs
StatePublished - Dec 1 2016

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Depression
Therapeutics
Antidepressive Agents
Randomized Controlled Trials
Biological Therapy
Cognitive Therapy
Meta-Analysis
Decision Making
Language
Databases
Exercise

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Farah, W. H., Alsawas, M., Mainou, M., Alahdab, F., Farah, M. H., Ahmed, A. T., ... Leblanc, A. (2016). Non-pharmacological treatment of depression: A systematic review and evidence map. Evidence-Based Medicine, 21(6), 214-221. https://doi.org/10.1136/ebmed-2016-110522

Non-pharmacological treatment of depression : A systematic review and evidence map. / Farah, Wigdan H.; Alsawas, Mouaz; Mainou, Maria; Alahdab, Fares; Farah, Magdoleen H.; Ahmed, Ahmed T.; Mohamed, Essa A.; Almasri, Jehad; Gionfriddo, Michael R.; Castaneda-Guarderas, Ana; Mohammed, Khaled; Wang, Zhen; Asi, Noor; Sawchuk, Craig; Williams, Mark D; Prokop, Larry J.; Murad, Mohammad H; Leblanc, Annie.

In: Evidence-Based Medicine, Vol. 21, No. 6, 01.12.2016, p. 214-221.

Research output: Contribution to journalReview article

Farah, WH, Alsawas, M, Mainou, M, Alahdab, F, Farah, MH, Ahmed, AT, Mohamed, EA, Almasri, J, Gionfriddo, MR, Castaneda-Guarderas, A, Mohammed, K, Wang, Z, Asi, N, Sawchuk, C, Williams, MD, Prokop, LJ, Murad, MH & Leblanc, A 2016, 'Non-pharmacological treatment of depression: A systematic review and evidence map', Evidence-Based Medicine, vol. 21, no. 6, pp. 214-221. https://doi.org/10.1136/ebmed-2016-110522
Farah WH, Alsawas M, Mainou M, Alahdab F, Farah MH, Ahmed AT et al. Non-pharmacological treatment of depression: A systematic review and evidence map. Evidence-Based Medicine. 2016 Dec 1;21(6):214-221. https://doi.org/10.1136/ebmed-2016-110522
Farah, Wigdan H. ; Alsawas, Mouaz ; Mainou, Maria ; Alahdab, Fares ; Farah, Magdoleen H. ; Ahmed, Ahmed T. ; Mohamed, Essa A. ; Almasri, Jehad ; Gionfriddo, Michael R. ; Castaneda-Guarderas, Ana ; Mohammed, Khaled ; Wang, Zhen ; Asi, Noor ; Sawchuk, Craig ; Williams, Mark D ; Prokop, Larry J. ; Murad, Mohammad H ; Leblanc, Annie. / Non-pharmacological treatment of depression : A systematic review and evidence map. In: Evidence-Based Medicine. 2016 ; Vol. 21, No. 6. pp. 214-221.
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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.",
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AU - Farah, Magdoleen H.

AU - Ahmed, Ahmed T.

AU - Mohamed, Essa A.

AU - Almasri, Jehad

AU - Gionfriddo, Michael R.

AU - Castaneda-Guarderas, Ana

AU - Mohammed, Khaled

AU - Wang, Zhen

AU - Asi, Noor

AU - Sawchuk, Craig

AU - Williams, Mark D

AU - Prokop, Larry J.

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N2 - 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.

AB - 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.

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