Effectiveness of psychotherapeutic, pharmacological, and combined treatments for chronic depression: a systematic review (METACHRON)

<p>Abstract</p> <p>Background</p> <p>Chronic depressions represent a substantial part of depressive disorders and are associated with severe consequences. Several studies were performed addressing the effectiveness of psychotherapeutic, pharmacological, and combined treatments for chronic depressions. Yet, a systematic review comparing the effectiveness of multiple treatment options and considering all subtypes of chronic depressions is still missing.</p> <p>Methods/Design</p> <p>Aim of this project is to summarize empirical evidence on efficacy and effectiveness of treatments for chronic depression by means of a systematic review. The primary objectives of the study are to examine, which interventions are effective; to examine, if any differences in effectiveness between active treatment options exist; and to find possible treatment effect modifiers. Psychotherapeutic, pharmacological, and combined treatments will be considered as experimental interventions and no treatment, wait-list, psychological/pharmacological placebo, treatment as usual, and other active treatments will be seen as comparators. The population of patients will include adults with chronic major depression, dysthymia, double depression, or recurrent depression without complete remission between episodes. Outcomes of the analyses are depressive symptoms, associated consequences, adverse events, and study discontinuation. Only randomized controlled trials will be considered.</p> <p>Discussion</p> <p>Given the high prevalence and serious consequences of chronic depression and a considerable amount of existing primary studies addressing the effectiveness of different treatments the present systematic review may be of high relevance. Special attention will be given to the use of current methodological standards. Findings are likely to provide crucial information that may help clinicians to choose the appropriate treatment for chronically depressed patients.</p

Network meta-analysis estimates of discontinuation rates due to adverse events for substance classes compared with placebo.

<p>Odds ratios higher than 1 reflect a higher discontinuation rate due to adverse events in the substance class arms, whereas odds ratios lower than 1 reflect a higher discontinuation rate due to adverse events in the placebo arms; OR = odds ratio; CI = confidence interval; aPS = antipsychotics (containing amisulpride and flupenthixol); Cmpl = complementary treatments (containing acetyl-l-carnitine); MAOI = monoamine oxidase inhibitors (containing moclobemide and phenelzine); oAD = other antidepressants (containing ritanserin and minaprine); Plac = placebo, sari = serotonin antagonist and reuptake inhibitor (containing trazodone); SSRI = selective serotonin reuptake inhibitors (containing sertraline, fluoxetine, escitalopram, and paroxetine); TCA = tricyclic antidepressants (containing imipramine, amineptine, and amitriptyline); ‘contrasts that are informed by at least one direct comparison to placebo.</p

Adverse event profiles for all investigated agents.

<p>Adverse event profiles for all investigated agents.</p