Comment: The quality of evidence is downgraded by study quality (inadequate allocation concealment), inconsistency (heterogeneity in interventions), imprecise results (small studies) and indirectness (short follow-up time).
A Cochrane review [Abstract] 1 included 60 studies. Among these, 54 studies (n=3021) were also included in the quantitative analyses. Most of the participants were from 30 to 40 years old. The first of primary outcomes, short-term (ST) remission (mean: 3 months), was most studied of all interventions by cognitive behaviour therapy (CBT, 32 studies), followed by behavior therapy (BT, 12 studies), physiological therapies (PT, 10 studies), cognitive therapy (CT, 3 studies), supportive psychotherapy (SP, 3 studies) and psychodynamic therapies (PD, 2 studies).The results showed the superiority of psychological therapies over the waiting list conditions. The network meta-analysis showed evidence in favour of CBT for short-term (ST) remission (OR 2.78, 95%CI0.54 to 14.29; 7 studies, n=357) and ST response (OR 7.14,95%CI 1.25 to 50; 7 studies, n=357), as well as some evidence in favour of PD and SP over other therapies. In terms of ST dropouts, PD and third-wave CBT showed better tolerability over other psychological therapies in the ST. In the long term, CBT and PD showed the highest level of remission/response, suggesting that the effects of these treatments may be more stable with respect to other psychological therapies.
Another Cochrane review [Abstract] 1 included 16 studies with a total of 966 patients. None of the studies reported long-term response/remission (at least 6 months).There was no difference between psychological therapies and selective serotonin reuptake inhibitors (SSRIs) in short-term remission (RR 0.85, 95% CI 0.62 to 1.17; 6 studies, n=334), short-term response (RR 0.97, 95% CI 0.51 to 1.86; 5 studies, n=277) or dropouts (RR 1.33, 95% CI 0.80 to 2.22; 6 studies, n=334).There was no difference between psychological therapies and tricyclic antidepressants in short-term remission (RR 0.82, 95% CI 0.62 to 1.09; 3 studies, n=229), short-term response (RR 0.75, 95% CI 0.51 to 1.10; 4 studies, n=270), or dropouts (RR 0.83, 95% CI 0.53 to 1.30; 5 studies, n=430).There was no difference between psychological therapies and other antidepressants in short-term remission (RR 0.90, 95% CI 0.48 to 1.67; 3 studies, n=135) or between psychological therapies and other antidepressants in short-term (RR 0.96, 95% CI 0.67 to 1.37; 3 studies, n=128) or dropouts for any reason (RR 1.55, 95% CI 0.91 to 2.65; 3 studies, n=180).There was no difference between psychological therapies and benzodiazepines in short-term remission (RR 1.08, 95% CI 0.70 to 1.65; 3 studies, n=95), short-term response (RR 1.58, 95% CI 0.70 to 3.58; 2 studies, n=69), or dropouts (RR 1.12, 95% CI 0.54 to 2.36; 3 studies, n=116).There was no difference between psychological therapies and either antidepressant alone or antidepressants plus benzodiazepines in short-term remission (RR 0.86, 95% CI 0.71 to 1.05; 11 studies, n=663) and short-term response (RR 0.95, 95% CI 0.76 to 1.18; 12 studies, n=800), or between psychological therapies and either antidepressants alone or antidepressants plus benzodiazepines in dropouts (RR 1.08, 95% CI 0.77 to 1.51; 13 studies, n=909).There were no data to contribute to a comparison between psychological therapies and serotonin-norepinephrine reuptake inhibitors (SNRIs) and subsequent adverse effects.
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