Psychological interventions for major depression in primary care: a meta-analytic review of randomized controlled trials.
OBJECTIVE
Various studies have tested psychological therapies in the treatment of depression in primary care. Yet, concerns over their clinical effectiveness, as compared to usual general practitioner (GP) care or treatment with antidepressants, have been raised. The present meta-analysis was aimed at assessing currently available evidence on the topic.


METHODS
A systematic search of electronic databases identified 10 randomized controlled trials comparing psychological forms of intervention with either usual GP care or antidepressant medication for major depression. Meta-analytical procedures were used to examine the impact of psychological intervention in primary care on depression, as compared to usual GP care and antidepressant treatment.


RESULTS
The main analyses showed greater effectiveness of psychological intervention over usual GP care in both the short term [standardized mean difference (SMD)=-0.42, 95% confidence interval (CI)=-0.59 to -0.26, n=408] and long term (SMD=-0.30, 95% CI=-0.45 to -0.14, n=433). The heterogeneity test was not significant in the short term at the P<.05 level (df=5, P=.57, I(2)=0%), but it was significant in the long term (df=5, P=.004, I(2)=70.9%). The comparison between psychological forms of intervention and antidepressant medication yielded no effectiveness differences, for either the short term or the long term.


CONCLUSIONS
Psychological forms of intervention are significantly linked to clinical improvement in depressive symptomatology and may be useful for supplementing usual GP care.
Bortolotti
Biancamaria
B
Institute of Psychiatry, Bologna University, Viale C. Pepoli, 5IT-40123 Bologna, Italy. biancamaria.bortolotti@unibo.it
Menchetti
Marco
M
Bellini
Francesca
F
Montaguti
Milena Barbara
MB
Berardi
Domenico
D
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000639:Amitriptyline / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use*; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use; D015928:Cognitive Behavioral Therapy / Q000379:methods; D003376:Counseling; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000523:psychology / Q000628:therapy*; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D016666:Fluvoxamine / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011613:Psychotherapy / Q000379:methods*; D011614:Psychotherapy, Brief / Q000379:methods; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data*; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D013813:Therapy, Computer-Assisted / Q000379:methods; D016896:Treatment Outcome
D000639:Amitriptyline; D000928:Antidepressive Agents; D000929:Antidepressive Agents, Tricyclic; D016666:Fluvoxamine; D017367:Selective Serotonin Reuptake Inhibitors