A systematic review and meta-analysis of psychological and pharmacological treatments for depression

Tags: Poster
Churchill R, Wessely S, Lewis G

Introduction: Depression affects about 20-30% of the population in the UK. About 90% of cases are managed in primary care using both physical and psychological treatments. Although the first line treatment for depression is still primarily the prescription of tricyclic antidepressants, psychological treatments are becoming increasingly available in primary care settings. The simultaneous use of medication and psychological treatments is controversial. Some believe that psychological treatments undermine the effect of antidepressants whilst advocates of psychological therapies have strong theoretical reasons for preventing patients from simultaneously receiving medication, despite the proven efficacy of antidepressants. Nevertheless, the possibility remains that the outcome is better for those treated with a combination of antidepressants and psychological treatments than it is for those treated with either one alone.

Objectives: To conduct a systematic review and meta-analysis of all randomised controlled trials comparing the effects of psychological and pharmacological treatments, alone and in combination, for depression.

Methods: Searches to be completed by July 1996. Electronic databases being searched: MEDLINE, Science Scisearch, Social Scisearch, PsycLit, EMBASE, PAHO and Information on Scientific and Technical Proceedings. Handsearching: Behaviour Research and Therapy, Cognitive Therapy and Research, International Clinical Psychopharmacology, Journal of Clinical Psychopharmacology. Bibliographies, "grey literature", book sections, theses and dissertations are also being identified and searched.

Results: A total of 23 reports have been identified pertaining to 10 trials conducted between 1974 and 1992. The quality of the trials is generally poor. Only one report identified so far describes the method of randomisation used. Intention to treat analyses have not been employed. Attrition rates, reasons for drop-out and point at which drop-out occurred are not specified. Only 3 trials have been followed up beyond the initial treatment period. Generalizability of the trials is questionable, with the majority of the trials having been conducted in the US, predominantly involving patients in secondary care settings. The final results will be ready for presentation at the Cochrane Colloquium in October 1996.