Abstract: Twelve studies (2215 participants) met the inclusion criteria and compared pharmacy-based management with treatment as usual. Two studies (291 participants) also included an active control (both used patient information leaflets providing information about the prescribed antidepressant). Neither of these studies reported depression symptom change. A narrative synthesis of results on acceptability of the intervention was inconclusive, with one study reporting better acceptability of pharmacy-based management and the other better acceptability of the active control. One study reported that participants in the pharmacy-based management group had better medication adherence than the control participants. One study reported adverse events with no difference between groups. The studies reported no other outcomes. Meta-analyses comparing pharmacy-based management with treatment as usual showed no evidence of a difference in the effect of the intervention on depression symptom change (dichotomous data; improvement in symptoms yes/no: risk ratio (RR), 0.95, 95% confidence interval (CI) 0.86 to 1.05; 4 RCTs, 475 participants; moderate-quality evidence; continuous data: standard mean difference (SMD) -0.04, 95% CI -0.19 to 0.10; 5 RCTs, 718 participants; high-certainty evidence), or acceptability of the intervention (RR 1.09, 95% CI 0.81 to 1.45; 12 RCTs, 2072 participants; moderate-certainty evidence). The risk of non-adherence was reduced in participants receiving pharmacy-based management (RR 0.73, 95% CI 0.61 to 0.87; 6 RCTs, 911 participants; high-certainty evidence). We were unable to meta-analyse data on diagnosis of depression, frequency of primary care appointments, quality of life, or social functioning. We found no evidence of a difference between pharmacy-based management for depression in adults compared with treatment as usual in facilitating depression symptom change. Based on numbers of participants leaving the trials early, there may be no difference in acceptability between pharmacy-based management and controls. However, there was uncertainty due to the low-certainty evidence.

Plain-language summary: We searched medical databases for well-designed studies that compared a group of adults with depression who received additional help with their depression medicines from their pharmacy with a group of adults with depression who received their treatment as usual. The evidence is current to 14 December 2018. We found 12 studies with over 2000 adults taking part. They compared pharmacy-based support with treatment as usual, for example, basic information about their medicines or signposting to other services only. We found that additional support given by the pharmacist was no better at reducing people's depression than their treatment as usual. The studies also showed that people may have liked both approaches the same, although we are uncertain about the results as the evidence was of low certainty. The studies did show that people who received support from their pharmacy were more likely to take their antidepressants as prescribed. We were not able to combine information from the included studies on other outcomes we were interested in (diagnosis of depression, frequency of healthcare appointments, quality of life, social functioning, or side effects). We found no difference in effectiveness when people with depression received additional support from a pharmacist compared with treatment as usual.