The long-term efficacy of psychotherapy, alone or in combination with antidepressants, in the treatment of adult major depression
Authors: Karyotaki Eirini , Smit Yolba , Cuijpers Pim , Debauche Monique , De Keyser Tom , Habraken Hilde , Pitchot William , Reas Filip , Salomez Dominique , Gillain Benoit , Fairon Nicolas , Paulus Dominique , Robays Jo , Holdt Henningsen Kirsten 
Published: January 2025

SCIENTIFIC REPORT 8 -- 1 INTRODUCTION 8 -- 1.1 INCIDENCE AND PREVALENCE 8 -- 1.2 DIAGNOSIS AND CLASSIFICATION OF MAJOR DEPRESSION. 9 -- 1.3 COURSE OF THE DISEASE 9 -- 2 OBJECTIVES AND SCOPE OF THIS GUIDELINE 10 -- 2.1 BACKGROUND 10 -- 2.2 THE NEED FOR A GUIDELINE 10 -- 2.3 SCOPE 10 -- 2.4 REMIT OF THE GUIDELINE 10 -- 2.4.1 Overall objectives 10 -- 2.4.2 Target users of the guideline 11 -- 2.5 STATEMENT OF INTENT 11 -- 2.6 FUNDING AND DECLARATION OF INTEREST 11 -- 3 METHODOLOGY 12 -- 3.1 INTRODUCTION 12 -- 3.2 THE GUIDELINE DEVELOPMENT GROUP 12 -- 3.3 CLINICAL RESEARCH QUESTIONS 12 -- 3.4 SELECTION CRITERIA 12 -- 3.4.1 Type of studies 12 -- 3.4.2 Definitions 12 -- 3.4.3 Type of patients 13 -- 3.4.4 Types of interventions 13 -- 3.4.5 Types of comparators 14 -- 3.4.6 Outcomes 14 -- 3.4.7 Power calculations 14 -- 3.5 SEARCH STRATEGY AND STUDY SELECTION 14 -- 3.6 QUALITY APPRAISAL 15 -- 3.7 DATA EXTRACTION, DESCRIPTION AND ANALYSIS 15 -- 3.7.1 Calculation of effect sizes 16 -- 3.7.2 Meta-analysis 16 -- 3.8 GRADING EVIDENCE 16 -- 3.9 FORMULATION OF RECOMMENDATIONS 19 -- 4 RESULTS RESEARCH QUESTION ONE 20 -- 4.1 SYSTEMATIC REVIEW 20 -- 4.1.1 Characteristics of included SR: MBCT vs. control groups 20 -- 4.1.2 Results of included SR: maintenance MBCT vs. control groups 20 -- 4.2 RCT 21 -- 4.2.1 Characteristics of included RCTs: psychotherapy (acute phase) vs. control groups 21 -- 4.2.2 Characteristics of included RCTs: maintenance psychotherapy vs. control groups 25 -- 4.2.3 Results of included RCTs: psychotherapy vs. control groups in adults with MDD, acute phase treatment 28 -- 4.2.4 Results of included RCTs: psychotherapy vs. control groups in adults who had had MDD, maintenance treatment 30 -- 4.3 CONCLUSIONS: MAIN PSYCHOTHERAPY INTERVENTIONS ONLY VS. NO TREATMENT 31 -- 5 RESULTS RESEARCH QUESTION TWO 31 -- 5.1 SYSTEMATIC REVIEWS 31 -- 5.1.1 Characteristics of included SRs: psychotherapy vs. ADM 31 -- 5.1.2 Results of included SRs: psychotherapy vs. ADM 32 -- 5.2 RCTS 33 -- 5.2.1 Characteristics of included RCTs: psychotherapy (acute phase) vs. ADM 33 -- 5.2.2 Characteristics of included RCTs: maintenance psychotherapy vs. ADM 35 -- 5.2.3 Results of included RCTs: psychotherapy vs. ADM in adults with MDD, acute phase treatment 37 -- 5.2.4 Results of included RCTs: psychotherapy vs. ADM in adults who had had MDD, maintenance treatment 38 -- 5.3 CONCLUSIONS: MAIN PSYCHOTHERAPY INTERVENTIONS ONLY VS. ANTIDEPRESSANTS 39 -- 6 RESULTS RESEARCH QUESTION THREE 39 -- 6.1 SYSTEMATIC REVIEWS 39 -- 6.2 RCTS 39 -- 6.2.1 Characteristics of included RCTs: combined psychotherapy and ADM (acute phase) vs. psychotherapy 39 -- 6.2.2 Characteristics of included RCTs: combined psychotherapy and ADM (acute phase) vs. ADM 41 -- 6.2.3 Characteristics of included RCTs: maintenance combined psychotherapy and ADM vs. maintenance psychotherapy 44 -- 6.2.4 Characteristics of included RCTs: maintenance combined psychotherapy and ADM vs. maintenance ADM 44 -- 6.2.5 Results of included RCTs: combined psychotherapy and ADM vs. psychotherapy in adults with MDD, acute phase treatment 46 -- 6.2.6 Results of included RCTs: combined psychotherapy and ADM vs. ADM in adults with MDD, acute phase treatment 47 -- 6.2.7 Results of included RCTs: combined psychotherapy with ADM vs. psychotherapy in adults who had had MDD, maintenance treatment 48 -- 6.2.8 Results of included RCTs: combined psychotherapy with ADM vs. ADM in adults who had had MDD, maintenance treatment 48 -- 6.3 CONCLUSIONS: MAIN PSYCHOTHERAPY INTERVENTIONS COMBINED WITH ANTIDEPRESSANTS VS. MAIN PSYCHOTHERAPY INTERVENTION OR ANTIDEPRESSANTS ONLY 49 -- 6.4 DISCUSSION 49 -- 7 OTHER CONSIDERATIONS 52 -- 7.1 BALANCE BETWEEN BENEFITS AND HARMS 52 -- 7.1.1 Side effects associated with anti-depressants 52 -- 7.1.2 Side-effects associated with psychotherapy 52 -- 7.2 QUALITY OF THE EVIDENCE 53 -- 7.3 COSTS (RESOURCE ALLOCATION) 53 -- 7.4 PATIENT VALUES AND PREFERENCES 53 -- 8 RECOMMENDATIONS 55 -- 8.1 PSYCHOTHERAPY ALONE, OR IN COMBINATION WITH ANTIDEPRESSANTS 55 -- 9 IMPLEMENTATION AND UPDATING OF THE GUIDELINE 58 -- 9.1 STAKEHOLDER INVOLVEMENT 58 -- 9.1.1 Consensus on recommendations 58 -- 9.1.2 Facilitators and barriers as identified by stakeholders 58 -- 9.2 DISSEMINATION AND IMPLEMENTATION 60 -- 9.3 MONITORING THE QUALITY OF CARE 60 -- 9.4 GUIDELINE UPDATE 60 -- APPENDICES 61 -- APPENDIX 1. DEFINITIONS OF TYPES OF PSYCHOTHERAPY FOR ADULT DEPRESSION11 61 -- REFERENCES 63