Can non-pharmacological interventions prevent relapse in adults who have recovered from depression? A systematic review and meta-analysis of randomised controlled trials.
OBJECTIVE
To identify studies of non-pharmacological interventions provided following recovery from depression, and to evaluate their efficacy in preventing further episodes.


METHODS
We identified relevant randomised controlled trials from searching MEDLINE, Embase, PsycINFO, CENTRAL, and ProQuest, searching reference and citation lists, and contacting study authors. We conducted a meta-analysis of relapse outcomes.


RESULTS
There were 29 eligible trials. 27 two-way comparisons including 2742 participants were included in the primary analysis. At 12months cognitive-behavioural therapy (CBT), mindfulness-based cognitive therapy (MBCT), and interpersonal psychotherapy (IPT) were associated with a 22% reduction in relapse compared with controls (95% CI 15% to 29%). The effect was maintained at 24months for CBT, but not for IPT despite ongoing sessions. There were no 24-month MBCT data. A key area of heterogeneity differentiating these groups was prior acute treatment. Other psychological therapies and service-level programmes varied in efficacy.


CONCLUSIONS
Psychological interventions may prolong the recovery a person has achieved through use of medication or acute psychological therapy. Although there was evidence that MBCT is effective, it was largely tested following medication, so its efficacy following psychological interventions is less clear. IPT was only tested following acute IPT. Further exploration of sequencing of interventions is needed.
PROSPERO 2011:CRD42011001646.
Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, UCL, 1-19 Torrington Place, London WC1E 7HB, United Kingdom. Electronic address: k.clarke@ucl.ac.uk.
Katherine
K
Clarke
Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, UCL, 1-19 Torrington Place, London WC1E 7HB, United Kingdom.
Evan
E
Mayo-Wilson
Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, UCL, 1-19 Torrington Place, London WC1E 7HB, United Kingdom.
Jocelyne
J
Kenny
Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, UCL, 1-19 Torrington Place, London WC1E 7HB, United Kingdom.
Stephen
S
Pilling
D015928:Cognitive Behavioral Therapy; D003866:Depressive Disorder / Q000517:prevention & control* / Q000523:psychology; D006801:Humans; D064866:Mindfulness; D012008:Recurrence; D055502:Secondary Prevention; D016896:Treatment Outcome
Depression; Long-term; Prevent; Psychological therapy; Relapse