title: Non-pharmacological treatment of depressive disorders: a review of evidence-based treatment options.
abstract: BACKGROUND
  The primary goals of this paper are to describe the collection and evaluation of various nonpharmacological treatment options for depressive disorders and to establish a basis for the development of a standard for the treatment of patients with depressive disorders.
  
  
  METHODS
  To identify evidence-based treatment elements, a comprehensive investigation of national and international guidelines was conducted. The extracted guidelines were then assessed with regard to aspects of methodological quality and evidence-based treatment elements. In a further step, specific and systematic literature searches for residual treatment elements were conducted. For the corresponding literature search, a hierarchical approach was chosen in which current guidelines were reviewed first and systematic reviews and meta-analyses second. Psychopharmacological treatments were excluded from the analysis because this is covered by specific guidelines.
  
  
  RESULTS
  The treatment elements with an adequate level of evidence were identified as follows: psychotherapeutic interventions, marital/couples/family therapy and counseling, inclusion of family members, psycho-education, exercise, problem solving therapy, guided self-help and behavioral activation treatments. Further evidence-based methods include diagnostic treatment elements, participative decision-making, development of the therapeutic alliance, Cognitive Behavioral Analysis System for Psychotherapy, computerized cognitive behavior therapy, psychopharmacological therapy, combined psychopharmacological and psychotherapeutic therapy, electroconvulsive therapy, phototherapy, sleep deprivation, repetitive trans-cranial magnetic stimulation (rTMS) and acupuncture.
  
  
  CONCLUSIONS
  In summary, using a hierarchical approach, it was possible to assign different levels of evidence to the various treatment options for depression.
authors.affiliation: University Medical Center Hamburg-Eppendorf, Department of Medical Psychology, Martinistraße 52, 20246 Hamburg, Germany. dirmaier@uke.de
authors.forename: J
authors.initials: J
authors.lastname: Dirmaier
authors.forename: M
authors.initials: M
authors.lastname: Steinmann
authors.forename: T
authors.initials: T
authors.lastname: Krattenmacher
authors.forename: B
authors.initials: B
authors.lastname: Watzke
authors.forename: D
authors.initials: D
authors.lastname: Barghaan
authors.forename: U
authors.initials: U
authors.lastname: Koch
authors.forename: H
authors.initials: H
authors.lastname: Schulz
mesh_terms: D003866:Depressive Disorder / Q000628:therapy*; D019317:Evidence-Based Medicine / Q000379:methods*; D006801:Humans; D011613:Psychotherapy / Q000379:methods*