title: Treatment of depressive disorders in primary care--protocol of a multiple treatment systematic review of randomized controlled trials.
abstract: BACKGROUND
  Several systematic reviews have summarized the evidence for specific treatments of primary care patients suffering from depression. However, it is not possible to answer the question how the available treatment options compare with each other as review methods differ. We aim to systematically review and compare the available evidence for the effectiveness of pharmacological, psychological, and combined treatments for patients with depressive disorders in primary care.
  
  
  METHODS
  To be included, studies have to be randomized trials comparing antidepressant medication (tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), hypericum extracts, other agents) and/or psychological therapies (e.g. interpersonal psychotherapy, cognitive therapy, behavioural therapy, short dynamically-oriented psychotherapy) with another active therapy, placebo or sham intervention, routine care or no treatment in primary care patients in the acute phase of a depressive episode. Main outcome measure is response after completion of acute phase treatment. Eligible studies will be identified from available systematic reviews, from searches in electronic databases (Medline, Embase and Central), trial registers, and citation tracking. Two reviewers will independently extract study data and assess the risk of bias using the Cochrane Collaboration's corresponding tool. Meta-analyses (random effects model, inverse variance weighting) will be performed for direct comparisons of single interventions and for groups of similar interventions (e.g. SSRIs vs. tricyclics) and defined time-windows (up to 3 months and above). If possible, a global analysis of the relative effectiveness of treatments will be estimated from all available direct and indirect evidence that is present in a network of treatments and comparisons.
  
  
  CONCLUSIONS
  Practitioners do not only want to know whether there is evidence that a specific treatment is more effective than placebo, but also how the treatment options compare to each other. Therefore, we believe that a multiple treatment systematic review of primary-care based randomized controlled trials on the most important therapies against depression is timely.
authors.affiliation: Institute of General Practice, Technische Universität München, Orleansstrasse 47, Munich, Germany. klaus.Linde@lrz.tum.de
authors.forename: Klaus
authors.initials: K
authors.lastname: Linde
authors.forename: Isabelle
authors.initials: I
authors.lastname: Schumann
authors.forename: Karin
authors.initials: K
authors.lastname: Meissner
authors.forename: Susanne
authors.initials: S
authors.lastname: Jamil
authors.forename: Levente
authors.initials: L
authors.lastname: Kriston
authors.forename: Gerta
authors.initials: G
authors.lastname: Rücker
authors.forename: Gerd
authors.initials: G
authors.lastname: Antes
authors.forename: Antonius
authors.initials: A
authors.lastname: Schneider
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003866:Depressive Disorder / Q000628:therapy*; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D011320:Primary Health Care / Q000379:methods*; D011613:Psychotherapy / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D000078202:Systematic Reviews as Topic
chemical_list: D000928:Antidepressive Agents
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