Relaxation for depression

Anthony F Jorm; Amy J Morgan; Sarah E Hetrick

doi:10.1002/14651858.CD007142.pub2

Relajación para la depresión

Contraer todo Desplegar todo

Referencias

Referencias de los estudios incluidos en esta revisión

Ir a:

estudios excluidos
estudios en curso
otras referencias

Bowers WA. Treatment of depressed in‐patients: Cognitive therapy plus medication, relaxation plus medication, and medication alone. British Journal of Psychiatry 1990;156:73‐8.

Byrne TM. The differential effects of paradoxical intention and relaxation training upon insomnia in depressed and non‐depressed subjects. Hempstead, NY: Hofstra University, 1984.

Field TM, Grizzle N, Scafidi F, Schanberg S. Massage and relaxation therapies' effects on depressed adolescent mothers. Adolescence 1996;31(124):903‐11.

Field T, Diego MA, Hernandez‐Reif M, Schanberg S, Kuhn C. Massage therapy effects on depressed pregnant women. Journal of Psychosomatic Obstetrics & Gynecology 2004;25(2):115‐22.

Kahn JS, Kehle TJ, Jenson WR, Clark E. Comparison of cognitive‐behavioral, relaxation, and self‐modeling interventions for depression among middle‐school students. School Psychology Review 1990;19(2):196‐211.

Krampen G. Long‐term evaluation of the effectiveness of additional autogenic training in the psychotherapy of depressive disorders. European Psychologist 1999;4(1):11‐8.

Krampen, G. Application of autogenic training before and in addition to integrative psychotherapy of depressive disorders [Autogenes Training vor und begleitend zur methodenübergreifenden Einzelpsychotherapie bei depressiven Störungen]. Zeitschrift Fur Klinische Psychologie, Psychiatrie Und Psychotherapie 1997;45(2):214‐32.

Google Scholar

McCann IL, Holmes DS. Influence of aerobic exercise on depression. Journal of Personality and Social Psychology 1984;46(5):1142‐7.

McLean P, Taylor S. Severity of unipolar depression and choice of treatment. Behaviour Research and Therapy 1992;30(5):443‐51.

McLean PD, Hakstian AR. Clinical depression: Comparative efficacy of outpatient treatments. Journal of Consulting and Clinical Psychology 1979;47(5):818‐36.

McLean PD, Hakstian AR. Relative endurance of unipolar depression treatment effects: Longitudinal follow‐up. Journal of Consulting and Clinical Psychology 1990;58(4):482‐8.

Taylor S, McLean P. Outcome profiles in the treatment of unipolar depression. Behaviour Research and Therapy 1993;31(3):325‐30.

Murphy GE, Carney RM, Knesevich MA, Wetzel RD, Whitworth P. Cognitive behavior therapy, relaxation training, and tricyclic antidepressant medication in the treatment of depression. Psychological Reports 1995;77(2):403‐20.

Pace FR. Behavioral techniques in the treatment of depression. Sydney, Australia: University of New South Wales, 1977.

Reynolds WM, Coats KI. A comparison of cognitive‐behavioral therapy and relaxation training for the treatment of depression in adolescents. Journal of Consulting and Clinical Psychology 1986;54(5):653‐60.

Sonis WA, Yellin AM, Garfinkel BD, Hoberman HH. The antidepressant effect of light in seasonal affective disorder of childhood and adolescence. Psychopharmacology Bulletin 1987;23(3):360‐3.

Wilson PH. Combined pharmacological and behavioural treatment of depression. Behaviour Research and Therapy 1982;20(2):173‐84.

Wood A, Harrington R, Moore A. Controlled trial of a brief cognitive‐behavioural intervention in adolescent patients with depressive disorders. Journal of Child Psychology and Psychiatry 1996;37(6):737‐46.

Referencias de los estudios excluidos de esta revisión

Ir a:

estudios incluidos
estudios en curso
otras referencias

Broota A, Dhir R. Efficacy of two relaxation techniques in depression. Journal of Personality and Clinical Studies 1990;6:83‐90.

Google Scholar

Brown RA, Evans DM, Miller IW, Burgess ES, Mueller TI. Cognitive‐behavioral treatment for depression in alcoholism. Journal of Consulting and Clinical Psychology 1997;65(5):715‐26.

Contreras D, Moreno M, Martinez N, Araya P, Livacic‐Rojas P, Vera‐Villarroel P. The effect of a cognitive‐behavioral intervention on emotional variables in older adults. Revista Latinoamericana de Psicologia 2006;38(1):45‐58.

Google Scholar

Corrado P, Gottlieb H. The effect of biofeedback and relaxation training on depression in chronic pain patients. American Journal of Pain Management 1999;9(1):18‐21.

Google Scholar

DeBerry S. The effects of meditation‐relaxation on anxiety and depression in a geriatric population. Psychotherapy: Theory, Research & Practice 1982;19(4):512‐21.

DeBerry S, Davis S, Reinhard KE. A comparison of meditation‐relaxation and cognitive/behavioral techniques for reducing anxiety and depression in a geriatric hospital. Journal of Geriatric Psychiatry 1989;22:231‐47.

DeVaney SB. Comparative effects of exercise reduction and relaxation training on Type A behavior and dysphoric mood states in habitual aerobic exercisers. Dissertation Abstracts International 1991;52(1‐B):0558.

Google Scholar

Field TM, Martinez A, Nawrocki T, Pickens J, Fox NA, Schanberg S. Music shifts frontal EEG in depressed adolescents. Adolescence 1998;33(129):109‐16.

Goodwin LK. The efficacy of guided imagery to enhance approach coping, emotional expressiveness, and psychological well‐being of women with breast cancer. Dissertation Abstracts International 2004;65(5‐A):1676.

Google Scholar

Halonen JS, Passman RH. Relaxation training and expectation in the treatment of postpartum distress. Journal of Consulting and Clinical Psychology 1985;53(6):839‐45.

Holland JC, Morrow GR, Schmale A, Derogatis L, Stefanek M, Berenson S, Carpenter PJ, Breitbart W, Feldstein M. A randomized clinical trial of alprazolam versus progressive muscle relaxation in cancer patients with anxiety and depressive symptoms. Journal of Clinical Oncology 1991;9(6):1004‐11.

Keyes JA. Cognitive distortions and loneliness: does changing negative thoughts affect loneliness?. Dissertation Abstracts International 1991;52(6‐B):3298.

Google Scholar

Kirkpatrick PW. The efficacy of cognitive behavior modification in the treatment of depression. Dissertation Abstracts International 1977;38(5‐B):2370.

Google Scholar

Klein MH, Greist JH, Gurman AS, Neimeyer RA, Lesser DP, Bushnell NJ, et al. A comparative outcome study of group psychotherapy vs. exercise treatments for depression. International Journal of Mental Health 1985;13(3‐4):148‐77.

Google Scholar

Knubben K, Reischies F M, Adli M, Schlattmann P, Bauer M, Dimeo F. A randomised, controlled study on the effects of a short‐term endurance training programme in patients with major depression. British Journal of Sports Medicine 2007;41:29‐33.

Krishnamurthy MN, Telles S. Assessing depression following two ancient Indian interventions: effects of yoga and ayurveda on older adults in a residential home. Journal of Gerontological Nursing 2007;33(2):17‐23.

Leppamaki SJ, Partonen TT, Hurme J, Haukka JK, Lonnqvist JK. Randomized trial of the efficacy of bright‐light exposure and aerobic exercise on depressive symptoms and serum lipids. Journal of Clinical Psychiatry 2002;63(4):316‐21.

Leppamaki S, Haukka J, Lonnqvist J, Partonen T. Drop‐out and mood improvement: a randomised controlled trial with light exposure and physical exercise [ISRCTN36478292]. BMC Psychiatry 2004;4:22.

Lolak S, Connors G, Sheridan M, Shumway J, Hess S, Farrell S. Effects of progressive relaxation on depression and anxiety in COPD patients. 158th Annual Meeting of the American Psychiatric Association. Atlanta, 2005.

Google Scholar

Maher, J. A randomised controlled trial to evaluate the use of aromatherapy massage and relaxation therapies in improving quality of life in patients with advanced cancer. National Research Register .

Parandeh A, Sirati M, Khaghani M, Karimi A A. The effect of training progress muscle relaxation of quality of life on spouses of war veterans psychiatric disorders. Psychiatry: Uniqueness and universality. Proceedings of the World Psychiatric Association International Congress; 2006 July 12‐16; Istanbul, Turkey. 2006:351‐2.

Google Scholar

Partonen T, Leppamaki S, Hurme J, Lonnqvist J. Randomized trial of physical exercise alone or combined with bright light on mood and health‐related quality of life. Psychological Medicine 1998;28(6):1359‐64.

Petersen RW, Quinlivan JA. Preventing anxiety and depression in gynaecological cancer: a randomised controlled trial. BJOG: An International Journal of Obstetrics and Gynaecology 2002;109(4):386‐94.

Richards CA. The use of biofeedback‐assisted relaxation training as an enabling strategy with chronically ill patients. Dissertation Abstracts International 1988;48(9‐B):2792‐3.

Google Scholar

Roth DL. An experimental comparison of the cardiovascular and self‐reported health effects of aerobic exercise and progressive relaxation. Dissertation Abstracts International 1987;48(5‐B):1522.

Google Scholar

Shaw E, Herman J. The effect of progressive relaxation and audio book tapes on anxiety and mood state in primiparous women. Journal of Perinatal Education 1994;3:29‐37.

Google Scholar

Sloan ME. The reduction of learned helplessness and depression deficits through relaxation and success experiences. Dissertation Abstracts International 1981;42(5‐B):2034.

Google Scholar

Sloman R. Relaxation and imagery for anxiety and depression control in community patients with advanced cancer. Cancer Nursing 2002;25(6):432‐5.

Swenson C. The relationship between mood elevation and attribution change in the reduction of depression. Dissertation Abstracts International 1986;46(11‐B):4031.

Google Scholar

Warren PA. The comparison of relaxation techniques in reducing cognitive and somatic responses in oncology patients. Dissertation Abstracts International 1995;55(11‐B):5091.

Google Scholar

Watts FN, MacLeod AK, Morris L. A remedial strategy for memory and concentration problems in depressed patients. Cognitive Therapy and Research 1988;12(2):185‐93.

Wetzel RD, Murphy GE, Carney RM, Whitworth P, et al. Prescribing therapy for depression: The role of learned resourcefulness: A failure to replicate. Psychological Reports 1992;70(3, Pt 1):803‐7.

Referencias de los estudios en curso

Ir a:

estudios incluidos
estudios excluidos
otras referencias

Pilot study of the short‐term effects of a multi‐sensory environment (MSE) on elderly patients suffering from depression. Ongoing study 1 September 2003.

Krogh J, Petersen L, Timmermann M, Saltin B, Nordentoft M. Design paper: The DEMO trial: A randomized, parallel‐group, observer‐blinded clinical trial of aerobic versus non‐aerobic versus relaxation training for patients with light to moderate depression. Contemporary Clinical Trials 2007;28:79‐89.

Referencias adicionales

Ir a:

estudios incluidos
estudios excluidos
estudios en curso

Andrews G, Sanderson K, Slade T, Issakidis G. Why does the burden of disease persist? Relating the burden of anxiety and depression to effectiveness of treatment. Bulletin of the World Health Organization 2000;78:446‐54.

American Psychiatric Association. Practice Guideline for the Treatment of Patients with Major Depressive Disorder. 2nd Edition. Washington, DC: American Psychiatric Association, 2000.

Beck AT, Ward CH. An inventory for measuring depression. Archives of General Psychiatry 1961;4:561‐71.

Beck AT, Steer RA, Brown GK. Manual for the BDI‐II. San Antonio, TX: The Psychological Corporation, 1996.

Bernstein DA, Borkovec TD. Progressive relaxation training: a manual for the helping professions. Champaign: Research Press, 1973.

Cuijpers P, Dekker J. Psychological treatment of depression; a systematic review of meta‐analyses [Psychologische behandeling van depressie; een systematisch overzicht van meta‐analysen]. Nederlands Tijdschrift Voor Geneeskunde 2005;149:1892‐7.

DerSimonian R, Laird N. Meta‐analysis in clinical trials. Controlled Clinical Trials 1986;7:177‐88.

Eaton WW, Badawi M, Melton B. Prodromes and precursors: epidemiologic data for primary prevention of disorders with slow onset. American Journal of Psychiatry 1995;152:967‐72.

Google Scholar

Endicott J, Spitzer R, Fleiss J, Cohen J. The Global Assessment Scale: a procedure for measuring overall severity of psychiatric disturbance. Archives of General Psychiatry 1976;33:766‐71.

Fava GA, Grandi S, Canestrari R, Molnar G. Prodromal symptoms in primary major depressive disorder. Journal of Affective Disorders 1990;19(2):149‐52.

Feighner JP, Robins E, Guze SB, Woodruff RA, Winokur G, Munoz R. Diagnostic criteria for use in psychiatric research. Archives of General Psychiatry 1972;26:57‐63.

Fergusson DM, Horwood LJ, Ridder EM, Beautrais AL. Subthreshold depression in adolescence and mental health outcomes in adulthood. Archives of General Psychiatry 2005;62:66‐72.

Gloaguen V, Cottraux J, Cucherat M, Blackburn I‐M. A meta‐analysis of the effects of cognitive therapy in depressed patients. Journal of Affective Disorders 1998;49:59‐72.

Goldberg D. The detection of psychiatric illness by questionnaire. Oxford: Oxford University Press, 1972.

Gompertz P, Pound P, Ebrahim S. The reliability of stroke outcome measurement. Clinical Rehabilitation 1993;7:290‐6.

Guy W. Early Clinical Drug Evaluation Unit (ECDEU) assessment manual for psychopharmacology (DHEW No. (ADM) 76‐338). Rockville, MD: Department of Health, Education, and Welfare, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, NIMH Psychopharmacology Research Branch, Division of Extramural Research Programs, 1976.

Hamilton M. A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry 1960;23:56‐62.

Hamilton M. Development of a rating scale for primary depressive illness. British Journal of Social and Clinical Psychology 1967;6:278‐96.

Harrington RC, Fudge H, Rutter M, Pickles A, Hill J. Adult outcomes of childhood and adolescent depression: II. Links with antisocial disorders. Journal of the American Academy of Child and Adolescent Psychiatry 1991;30:434‐9.

Hazell P, O'Connell D, Heathcote D, Henry D. Tricyclic drugs for depression in children and adolescents. Cochrane Database of Systematic Reviews 2002, Issue 2.

Hetrick SE, Merry S, McKenzie J, Sindahl P, Proctor M. Selective serotonin reuptake inhibitors (SSRIs) for depressive disorders in children and adolescents. Cochrane Database of Systematic Reviews 2007, Issue 3.

Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions 4.2.5 [updated May 2005]. www.cochrane.org/resources/handbook/hbook.htm (accessed 15 August 2006).

Jiang W, Alexander J, Christopher E, Kuchibhatla M, Gaulden LH, Cuffe MS, et al. Relationship of depression to increased risk of mortality and rehospitalization in patients with congestive heart failure. Archives of Internal Medicine 2001;161:1849‐56.

Jorm AF. Mental health literacy: public knowledge and beliefs about mental disorders. British Journal of Psychiatry 2000;177:396‐401.

Jorm AF, Christensen J, Griffiths KM, Rodgers B. Effectiveness of complementary and self‐help treatments for depression. Medical Journal of Australia 2002;176:S84‐96.

Jorm AF, Allen NB, O’Donnell CP, Parslow RA, Purcell R, Morgan AJ. Effectiveness of complementary and self‐help treatments for depression in children and adolescents. Medical Journal of Australia 2006;185(7):368‐72.

Jorm AF, Christensen H, Griffiths KM. The public's ability to recognize mental disorders and their beliefs about treatment: changes in Australia over 8 years. Australian and New Zealand Journal of Psychiatry 2006;40:36‐41.

Jorm AF, Wright A. Beliefs of young people and their parents about the effectiveness of interventions for mental disorders. Australian and New Zealand Journal of Psychiatry 2007;41:656‐66.

Judd LL, Paulus MP, Wells KB, Rapaport MH. Socioeconomic burden of subsyndromal depressive symptoms and major depression in a sample of the general population. American Journal of Psychiatry 1996;153:1411‐7.

Google Scholar

Kaufman J, Birmaher B, Brent D, Rao U, Flynn C, Moreci P, et al. Schedule for Affective Disorders and Schizophrenia for School‐Age Children‐Present and Lifetime Version (K‐SADS‐PL): Initial reliability and validity data. Journal of the American Academy of Child and Adolescent Psychiatry 1997;36(7):980‐8.

Kohn R, Saxena S, Levav I, Saraceno B. The treatment gap in mental health care. Bulletin of the World Health Organization 2004;82:858‐66.

Kovacs M. The Children's Depression Inventory. Psychopharmacology Bulletin 1985;21(4):995‐8.

Kurlowicz L. The Geriatric Depression Scale (GDS). Geriatric Nursing 1999;20:212‐3.

Lubin B. Adjective Check Lists for the measurement of depression. Archives of General Psychiatry 1965;12:57‐62.

Lubin B. Depression Adjective Check Lists: Manual. San Diego, CA: Educational and Industrial Testing Service, 1967.

Mantel N, Haenszel W. Statistical aspects of the analysis of data from retrospective studies of disease. Journal of the National Cancer Institute 1959;22:719‐48.

Maratos AS, Gold C, Wang X, Crawford MJ. Music therapy for depression. Cochrane Database of Systematic Reviews 2008, Issue 1.

McGorry PD, Hickie IB, Yung AR, Pantelis C, Jackson HJ. Clinical staging of psychiatric disorders: a heuristic framework for choosing earlier, safer and more effective interventions. Australian and New Zealand Journal of Psychiatry 2006;40:616‐22.

McMahon K, Winzenberg T, Mosby C, Nelson M. Yoga/meditation for depression. Protocol (in press). Cochrane Database of Systematic Reviews .

Moher D, Schulz KF, Altman DG. The CONSORT statement: revised recommendations for improving the quality of reports of parallel group randomized trials. BMC Medical Research Methodology 2001;1:2.

Montgomery SA, Asberg M. A new depression scale designed to be sensitive to change. British Journal of Psychiatry 1979;134:382‐9.

Mrazek PJ, Haggerty RJ. Reducing risks for mental disorders: Frontiers for preventive intervention research. Washington DC: National Academy Press, 1994.

NICE guidelines to improve the treatment and care of people with depression and anxiety 2004. National Institute for Clinical Excellence www.nice.org.uk.

Parker G, Crawford J. Judged effectiveness of differing antidepressant strategies by those with clinical depression. Australian and New Zealand Journal of Psychiatry 2007;41(1):32‐7.

Petti TA. Depression in hospitalized child psychiatry patients: Approaches to measuring depression. Journal of the American Academy of Child and Adolescent Psychiatry 1978;17:49‐59.

Poznanski EO, Cook SC, Carroll BJ. A depression rating scale for children. Pediatrics 1979;64(4):442‐50.

Radloff LS. The CES‐D scale: A self‐report depression scale for research in the general population. Applied Psychological Measurement 1977;1:385‐401.

Royal Australian and New Zealand College of Psychiatrists Clinical Practice Guidelines Team for Depression. Australian and New Zealand clinical practice guidelines for the treatment of depression. Australian and New Zealand Journal of Psychiatry 2004;38:389‐407.

Enlace al artículo

Rush AJ, Giles DE, Schlesser MA, Fulton CL, Weissenburger J, Burns CT. The Inventory for Depression Symptomatology (IDS): preliminary findings. Psychiatry Research 1986;18:65‐87.

Schultz JH, Luthe W. Autogenic training: a psychophysiologic approach in psychotherapy. New York: Grune and Stratton, 1959.

Spitzer RL, Endicott J, Robins E. Research Diagnostic Criteria (RDC) for a selected group of functional disorders. 3rd Edition. New York: New York State Psychiatric Institute, 1978.

Thachil AF, Mohan R, Bhugra D. The evidence base of complementary and alternative therapies in depression. Journal of Affective Disorders 2007;97:23‐35.

Ustun TB, Ayuso‐Mateos JL, Chatterji S, Mathers C, Murrary CJ. Global burden of depressive disorders in the year 2000. British Journal of Psychiatry 2004;184:386‐92.

Ware JE, Snow KK, Kosinski M, Gandek B. SF‐36 Health Survey: Manual and interpretation guide. Boston, MA: Health Institute, New England Medical Center, 1993.

Weisz JR, McCarty CA, Valeri SM. Effects of psychotherapy for depression in children and adolescents: a meta‐analysis. Psychological Bulletin 2006;132:132‐49.

Weller EB, Weller RA. Depression in adolescents: growing pains or true morbidity. Journal of Affective Disorders 2000;61:S9‐13.

Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica 1983;67:361‐70.

Zung WW. A self rating depression rating scale. Archives of General Psychiatry 1965;12:63‐70.

Characteristics of studies

Characteristics of included studies [ordered by study ID]

Ir a:

estudios excluidos
estudios en curso

Bowers 1990

Methods	Was allocation sequence adequately generated: No Was allocation adequately concealed: No Were interventions blinded to participant/provider: Not possible Were outcome assessors blinded: Not possible for self‐rated, yes for clinician rated Were drop outs adequately described: Yes Was ITT analysis undertaken: No Did authors report on all a‐priori outcomes: Yes Other: Medication group appears worse based on baseline anxiety and depression scores, no test for baseline differences reported Number randomised: 33 Number dropped out (relaxation): 1 Number dropped out (CT): 1 Number dropped out (medication only): 1
Participants	Primary or Secondary depression: Primary How was depression defined: Diagnosis using DSM‐III criteria by psychiatrist Setting: Inpatients Severity (relaxation): BDI 25.8, HRSD 16.5 Severity (CT): BDI 24.2, HRSD 20.7 Severity (medication only): BDI 31.2, HRSD 22.1 Age (relaxation): 37.7 Age (CT): 31.2 Age (medication only): 39.6 Sex (overall): M: 6 (20%), F: 24 (80%) Ethnicity (overall): Caucasian Suicidality: not stated Comorbid anxiety (relaxation): ATQ: 93.2 Comorbid anxiety (CT): ATQ: 101.9 Comorbid anxiety (medication only): ATQ: 121.0 Psychiatric comorbidity: not stated Recruitment strategy: from inpatient unit Country: USA Criteria for trial entry: Minimum 8th grade education, sufficient reading comprehension, aged between 18 and 60, written consent, no mental retardation, no specific physical illness, no active suicidal behaviour, no treatment with ECT, no contraindications for the use of antidepressants, none of bipolar affective disorder, panic disorder, alcoholism, drug use disorder, antisocial personality, Briquet's disorder, any psychotic depressive episode, schizophrenia, organic brain syndrome
Interventions	RELAXATION Type of relaxation: Two autogenic‐like procedures ‐ muscle relaxation and modified pain‐reduction procedure Individual/group: Individual Manualised: Yes Delivered by: The author, a trained therapist Length of sessions: 50 minutes Number of sessions: 12 Length of intervention: Average of 27 days in hospital, discharge approx. 9 days from the end of therapy How many sessions actually attended: Not stated Was it intended as intervention or control: Control Concurrent treatment: Antidepressant: dosage ranged from 25‐75mg/day at the start, and 100‐200mg/day at the end of the study (discharge dose 137.50mg/day). All subjects were in the normal hospital milieu PSYCHOLOGICAL THERAPY Type: Cognitive therapy (CT) Individual/group: Individual Manualised: Yes Delivered by: Author, trained therapist Length of sessions: Not stated Number of sessions: 12 Length of intervention: Average of 29.4 days in hospital, discharge approx. 11 days after the end of therapy How many sessions actually attended: Not stated Was it intended as intervention or control: Intervention Concurrent treatment: Antidepressant: dosage ranged from 25‐75mg/day at the start, and 100‐200mg/day at the end of the study (discharge dose 137.50mg/day). All subjects were in the normal hospital milieu ANTIDEPRESSANTS Type: Tricyclic: nortriptyline Dosage/regime of pharmacotherapy: dosage ranged from 25‐75mg/day at the start, and 100‐200mg/day at the end of the study. Length of intervention: Average of 31.90 days in hospital Discharge dose: 120.00mg/day Concurrent treatment: normal hospital milieu
Outcomes	1) Depression: Beck Depression Inventory (Beck et al, 1961, 1979) (self rated) 2) Depression: 17‐item Hamilton Rating Scale for Depression (Hamilton, 1960) (clinician rated) 3) Cognitive process and content: Dysfunctional Attitudes Scale (Weissman, 1979) (self rated) 4) Cognitive process and content: Automatic Thoughts Questionnaire (Hollon & Kendall, 1980) (self rated) 5) Cognitive process and content: Hopelessness Scale (Beck, Weissman, Lester, 1974) (self rated)
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	High risk	C ‐ Inadequate

Byrne 1984

Methods	Was allocation sequence adequately generated: Unclear Was allocation adequately concealed: Unclear Were interventions blinded to participant/provider: Not possible Were outcome assessors blinded: Not possible for self‐rated Were drop outs adequately described: Yes Was ITT analysis undertaken: N/A Did authors report on all a‐priori outcomes: No Other: Number randomised: 8 Number dropped out (relaxation): 0 Number dropped out (paradoxical intention): 0
Participants	Primary or Secondary depression: Primary How was depression defined: Cut‐off t score on MMPI Depression Scale > 70 & BDI > 10 Setting: University Severity (overall): BDI 17.38 Age (relaxation): 39.5Age (paradoxical intention): 43.0 Sex: not stated Ethnicity: not stated Suicidality: not stated Comorbid anxiety: not stated Psychiatric comorbidity: not stated Recruitment strategy: Newspaper advertisements and college campus posters Country: USA Criteria for trial entry: Aged 18‐55, average weekly sleep onset latency of >= 45 minutes, average of >= 3 nights per week difficulty falling asleep, subjects considered their sleep problem serious enough to warrant treatment, T score on MMPI Depression Scale > 70, BDI > 10.
Interventions	RELAXATION Type of relaxation: Progressive muscle relaxation Individual/group: Individual Manualised: Yes Delivered by: Therapist (5th year graduate student with 1.5 years supervised clinical experience) and self Length of sessions: Not stated Number of sessions: 21 Length of intervention: 3 weeks How many sessions actually attended: Not stated Was it intended as intervention or control: Intervention Concurrent treatment: None PSYCHOLOGICAL THERAPY Type: Thought monitoring in bed before going asleep Individual/group: Individual Manualised: Yes Delivered by: Therapist (5th year graduate student with 1.5 years supervised clinical experience) and self Length of sessions: not stated Number of sessions: 21 Length of intervention: 3 weeks How many sessions actually attended: Not stated Was it intended as intervention or control: Intervention Concurrent treatment: None
Outcomes	1) Depression: Beck Depression Inventory (BDI) (Beck et al, 1961) (self rated) 2) Depression: Minnesota Multiphasic Personality Inventory (MMPI) Depression Scale3) Objective sleep onset latency: Sleep monitoring unit4) Subject sleep parameters: Daily sleep log recorded subjective sleep onset latency, changes in frequency of nightly awakenings, early morning rising, difficulty in falling asleep, overall quality of sleep, bed and waking times, drug intake.
Notes	Data were not presented separately for each group so could not be pooled.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B ‐ Unclear

Field 1996

Methods	Was allocation sequence adequately generated: Unclear Was allocation adequately concealed: Unclear Were interventions blinded to participant/provider: Not possible Were outcome assessors blinded: Not possible for self‐rated, unclear for clinician rated Were drop outs adequately described: No Was ITT analysis undertaken: Unclear Did authors report on all a‐priori outcomes: Yes Other: Funds from Johnson & Johnson. Analysed acute changes on specific days rather than long term change over the intervention period Number randomised: 32 Number dropped out: not stated
Participants	Primary or Secondary depression: Primary (post‐natal) How was depression defined: Diagnosis of dysthymia on the Diagnostic Inventory Schedule (Costello et al, 1985) and cut‐off score on depression scale, BDI > 16 Setting: Outpatient at maternity unit Severity (relaxation): POMS 18.37 Severity (massage): POMS 19.44 Age (overall): 18.1 Sex (overall): 100% F Ethnicity (overall): 71% black, 29% Hispanic Suicidality: not stated Comorbid anxiety (relaxation): STAIC: 34.73 Comorbid anxiety (massage): STAIC: 35.67 Psychiatric comorbidity: not stated Recruitment strategy: Hospital maternity ward Country: USA Criteria for trial entry: Recently given birth, adolescent, free from medication or other treatment for depression or related disorders
Interventions	RELAXATION Type of relaxation: Combination of yoga exercises and progressive muscle relaxation Individual/group: Unclear Manualised: Not stated Delivered by: Not stated Length of sessions: 30 minutes Number of sessions: 10 Length of intervention: 5 weeks How many sessions actually attended: Not stated Was it intended as intervention or control: Intervention Concurrent treatment: None MASSAGE THERAPY Individual/group: Individual Manualised: Yes Delivered by: Trained massage therapists Length of sessions: 30 minutes Number of sessions: 10 Length of intervention: 5 weeks How many sessions actually attended: Not stated Was it intended as intervention or control: Intervention Concurrent treatment: None
Outcomes	1) Depressed mood: Profile of Mood States (McNair et al, 1971) (self rated) 2) State, affect, activity level, anxiety level, fidgeting/nervous behaviour, vocalizations, cooperation: Behavior Observation Scales (Platania‐Solazzo et al, 1992) (clinician rated) 3) State anxiety: State Anxiety Inventory for Children (Spielberger et al, 1970) (self rated) 4) Pulse rate: Radial pulse 5) Cortisol: Sampled from saliva and urine
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B ‐ Unclear

Field 2004

Methods	Was allocation sequence adequately generated: Unclear Was allocation adequately concealed: Unclear Were interventions blinded to participant/provider: Not possible Were outcome assessors blinded: Not possible for self‐rated, yes for clinician rated Were drop outs adequately described: No Was ITT analysis undertaken: Unclear Did authors report on all a‐priori outcomes: Yes Other: Funding by Johnson & Johnson, conducted by Touch Research Institutes Number randomised:84 Number dropped out: not stated
Participants	Primary or Secondary depression: Primary (in pregnant women) How was depression defined: Not stated. Setting: Participants' own home Severity (relaxation): CES‐D 26.2 Severity (massage): CES‐D 24.9 Severity (control): CES‐D 28.3 Age (overall): 28.8 Sex (overall): 100% F Ethnicity (overall): 46% Caucasian, 39% Hispanic, 12% African American, 3% Asian Suicidality: not stated Comorbid anxiety (relaxation): STAI: 45.5 Comorbid anxiety (massage): STAI: 37.4 Comorbid anxiety (control): STAI: 36.4 Psychiatric comorbidity: not stated Recruitment strategy: From obstetric and gynaecology clinics Country: USA Criteria for trial entry: Depressed, pregnant ‐ second trimester (18‐24 weeks gestation)
Interventions	RELAXATION Type of relaxation: Progressive muscle relaxation Individual/group: Individual Manualised: Not stated Delivered by: Self, once instructed by researchers Length of sessions: 20 minutes Number of sessions: 32 Length of intervention: 16 weeks How many sessions actually attended: Not stated Was it intended as intervention or control: Control Concurrent treatment: Standard prenatal care MASSAGE THERAPY Individual/group: Individual Manualised: Yes Delivered by: Participants' significant other Length of sessions: 20 minutes Number of sessions: 32 Length of intervention: 16 weeks How many sessions actually attended: Not stated Was it intended as intervention or control: Intervention Concurrent treatment: Standard prenatal care NO TREATMENT CONTROL Concurrent treatment: Standard prenatal care
Outcomes	1) Depression: Center for Epidemiologic Studies‐Depression (Radloff, 1977) (self rated) 2) Depressed mood: Profile of Mood States (McNair et al, 1971) (self rated) 3) State anxiety: State Anxiety Inventory (Spielberger et al, 1970) (self rated) 4) Leg and back pain: VITAS (VITAS Healthcare Corporation, 1993) (self rated) 5) Cortisol, catecholamines, serotonin: Urine samples 6) Fetal activity: ultrasound 7) Obstetric complications: Obstetric Complications (OCS) and Postnatal Factor (PNF) Scales (Littman et al, 1978) 8) Neonatal behaviour: Brazelton Neonatal Behavior Assessment Scale (Brazelton, 1984) (clinician rated)
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B ‐ Unclear

Kahn 1990

Methods	Was allocation sequence adequately generated: Unclear Was allocation adequately concealed: No Were interventions blinded to participant/provider: Not possible Were outcome assessors blinded: Not possible for self‐rated, no for clinician rated Were drop outs adequately described: No Was ITT analysis undertaken: Unclear Did authors report on all a‐priori outcomes: Yes Other: Large standard deviations; ethical practice required that the four special education students classified as behaviourally disordered be assured of placement in one of the three active treatment conditions, making these participants not truly randomised Number randomised: 68 Number dropped out (relaxation): 0 Number dropped out (CWD): 0 Number dropped out (self‐modelling): 0 Number dropped out (control): 1 during follow‐up
Participants	Primary or Secondary depression: Primary How was depression defined: Cut‐off on depression scales: RADS>72, CDI>15, BID>20 Setting: School Severity (overall): moderate to severe (RADS in the 95th percentile) Age (overall): 10 ‐ 14 Sex (overall): M: 33 (48.5%), F: 35 (51.5%) Ethnicity: not stated Suicidality: not stated Comorbid anxiety: not stated Psychiatric comorbidity: not stated Recruitment strategy: Multiple stage screening process at a high school to obtain a high risk sample Country: USA Criteria for trial entry: Not receiving antidepressant medication or other treatment for depression, student willingness and parent permission, aged 10‐14
Interventions	RELAXATION Type of relaxation: progressive muscle plus psychoeducation including mental imagery and breathing Individual/group: Group Manualised: Yes Delivered by: School psychologist and school counsellor Length of sessions: 50 minutes Number of sessions: 12 Length of intervention: 6‐8 weeks How many sessions actually attended: Not stated Was it intended as intervention or control: Intervention Concurrent treatment: None PSYCHOLOGICAL THERAPY 1 Type: CWD Adolescent (cognitive behaviour and psychoeducation) Individual/group: Group Manualised: Yes Delivered by: School psychologist and school counsellor Length of sessions: 50 minutes Number of sessions: 12 Length of intervention: 6‐8 weeks How many sessions actually attended: Not stated Was it intended as intervention or control: Intervention Concurrent treatment: None PSYCHOLOGICAL THERAPY 2 Type: self modelling ‐ behavioural/cognitive Individual/group: Individual Manualised: Yes Delivered by: School psychologist and school counsellor Length of sessions: 10‐12 minutes Number of sessions: 12 Length of intervention: 6‐8 weeks How many sessions actually attended: Not stated Was it intended as intervention or control: Intervention Concurrent treatment: None WAIT‐LIST CONTROL
Outcomes	1) Depression: Reynolds Adolescent Depression Scale (RADS) (Reynolds, 1987) (self rated) 2) Depression: Adapted Children's Depression Inventory (CDI) (Kovacs, 1985) (self rated) 3) Depression: Bellevue Index of Depression (BID) (Petti, 1978) (clinician rated) 4) Depression: RADS and CDI ‐ parent rated 5) Self concept: Piers‐Harris Childrens Self Concept Scale (Piers (1984) 6) Satisfaction: Rating scale
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	High risk	C ‐ Inadequate

Krampen 1997

Methods	Was allocation sequence adequately generated: No Was allocation adequately concealed: No Were interventions blinded to participant/provider: Not possible Were outcome assessors blinded: Not possible for depression Were drop outs adequately described: Yes Was ITT analysis undertaken: No Did authors report on all a‐priori outcomes: No Other problems: 10‐week intervention showed only small improvements in depression scores. Number randomised: 55 Number dropped out (relaxation): 0 Number dropped out (psychological therapy): 3 Number dropped out (waitlist): 4
Participants	Primary or Secondary depression: Primary How was depression defined: ICD‐10 and German version of Structured Clinical Interview for DSM‐III‐R Patient Edition (SCID‐P; Wittchen et al., 1990) Setting: Outpatients Severity (relaxation): BDI: 26.8 Severity (psychological therapy): BDI: 25.4 Severity (control): BDI: 24.9 Age (mean): 41.3 Sex (overall): M: 17 (30.9%), F: 38 (69.1%) Ethnicity: not reported Suicidality: not reported Comorbid anxiety: not reported Psychiatric comorbidity: not reported Recruitment strategy: Unselected sample, recruited from psychotherapy outpatients Country: Germany Criteria for trial entry: Adult, ICD‐10 diagnosis of depressive episode (F32.xx), long term depressive reaction (F43.21), recurrent depression (F33.xx), or dysthymia (F34.1)
Interventions	RELAXATION Type of relaxation: Autogenic training Individual/group: Group Manualised: Yes Delivered by: 6 experienced psychotherapists with > 8 years practice with training and certification for behavior therapy or cognitive therapy plus one more approach Length of sessions: Not reported Number of sessions: 10 Length of intervention: 10 weeks How many sessions actually attended: Not reported Was it intended as intervention or control: Intervention Concurrent treatments: 8 of 19 were taking antidepressants at baseline PSYCHOLOGICAL THERAPY Type: "Integrative" (behavior oriented, problem‐centred, supportive treatment, psychodynamic oriented) Individual/group: Individual Manualised: No Delivered by: 6 experienced psychotherapists with > 8 years practice with training and certification for behavior therapy or cognitive therapy plus one more approach Length of sessions: Not reported Number of sessions: 20 Length of intervention: 10 weeks How many sessions actually attended: Not reported Was it intended as intervention or control: Intervention Concurrent treatments: 7 of 18 were taking antidepressants at baseline WAITLIST CONTROL Concurrent treatments: 8 of 18 were taking antidepressants at baseline
Outcomes	1) Depression: German version of Beck Depression Inventory (self report) (BDI; Hautzinger et al., 1994) 2) Depression: German version of Structured Clinical Interview for DSM‐III‐R Patient Edition (SCID‐P; Wittchen et al., 1990) 3) Psychosomatic complaints: Symptom Checklist for Autogenic Training (AT‐SYM; Krampen 1991)
Notes	Cross‐over study: data extracted from pre‐crossover only. Study also had assessments at 20 weeks, 8 months and 3 years.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	High risk	C ‐ Inadequate

McCann 1984

Methods	Was allocation sequence adequately generated: Unclear Was allocation adequately concealed: Unclear Were interventions blinded to participant/provider: Not possible Were outcome assessors blinded: Not possible for self‐rated Were drop outs adequately described: Unclear (number of dropouts per group described, but not the reasons for dropout) Was ITT analysis undertaken: No Did authors report on all a‐priori outcomes: No Other problems: Relaxation intervention was minimal and was not implemented with the same thoroughness as aerobic exercise intervention Number randomised: 47 Number dropped out (relaxation): 1 Number dropped out (exercise): 1 Number dropped out (no treatment): 2
Participants	Primary or Secondary depression: Primary How was depression defined: Cut‐off on depression scale: BDI > 11 Setting: University Severity (overall): BDI 15.35 Age: not stated Sex (overall): 47 female (100%) Ethnicity: not stated Suicidality: not stated Comorbid anxiety: not stated Psychiatric comorbidity: not stated Recruitment strategy: Screening of female undergraduate psychology students Country: USA Criteria for trial entry: Female, willingness to participate
Interventions	RELAXATION Type of relaxation: Jacobson or derivative Individual/group: Individual Manualised: No Delivered by: Self Length of sessions: 15‐20 minutes Number of sessions: 40 Length of intervention: 10 weeks How many sessions actually attended: Not reported Was it intended as intervention or control: Control Concurrent treatment: Subjects began their relaxation sessions with a 5 minute leisurely walk EXERCISE Type: Aerobic exercise Individual/group: Group Manualised: Unclear Delivered by: Aerobics instructor and self Length of sessions: 1 hour Number of sessions: 20, plus exercise outside class for total of 30 aerobic points per week Length of intervention: 10 weeks How many sessions actually attended: Not stated Was it intended as intervention or control: Intervention Concurrent treatment: None NO TREATMENT CONTROL
Outcomes	1) Depression: Beck Depression Inventory (Beck et al, 1961) (self rated) 2) Aerobic capacity: Distance travelled during 12 minute walk‐run test 3) MHPG (norepinephrine): Urine samples (destroyed during preservation process)
Notes	Means were estimated from Figure 1. SDs were imputed from results of post hoc paired comparison t‐tests.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B ‐ Unclear

McLean 1979

Methods	Was allocation sequence adequately generated: Unclear Was allocation adequately concealed: Unclear Were interventions blinded to participant/provider: Not possible Were outcome assessors blinded: Not possible for self‐rated Were drop outs adequately described: Unclear Was ITT analysis undertaken: Unclear Did authors report on all a‐priori outcomes: Yes Other problems: Significantly fewer dropouts in the behavior therapy group than in the psychological therapy or drug therapy group Number randomised: 196 Number dropped out (relaxation): 10 Number dropped out (behavior therapy): 2 Number dropped out (antidepressants): 14 Number dropped out (short term psychological therapy): 11
Participants	Primary or Secondary depression: Primary How was depression defined: Diagnosis by diagnostic criteria for psychiatric research (Feighner et al 1972), plus 2 or more of BDI >= 23, DACL >= 14, MMPI Depression Scale >= 25 for men, >= 29.5 for women Setting: Community Severity (relaxation): BDI: 26.79 Severity (antidepressants): BDI 27.23 Severity (behaviour therapy): BDI 26.75 Severity (short term psychological therapy): BDI 26.96 Age (overall): 39.2 Sex (overall): M: 28%, F: 72% Ethnicity: not stated Suicidality (overall): 25% had made a serious suicide attempt Comorbid anxiety: not stated Psychiatric comorbidity: not stated Recruitment strategy: Newspaper announcements Country: Canada Criteria for trial entry: Aged between 20 and 60, if recently pregnant at least 3 months postpartum, depressed for at least the past 2 months, functionally impaired, fluent in English, not receiving treatment for depression elsewhere, not taking Lithium
Interventions	RELAXATION Type of relaxation: Progressive muscle relaxation Individual/group: Individual Manualised: Yes Delivered by: Psychologists, physicians or psychiatrists Length of sessions: 1 hour Number of sessions: 10 Length of intervention: 10 weeks How many sessions actually attended: Not stated Was it intended as intervention or control: Control Concurrent treatment: None ANTIDEPRESSANTS Type: Tricyclic: Amitriptyline Dose/regimen of pharmacotherapy: Initial dose 75mg up to 150mg/day over a 10 day period, then weaned at 25mg/day at end of trial Length of pharmacotherapy: 11 weeks How much medication received: Dosage not reported, but blood samples taken on 2 random visits indicated 100% were taking antidepressants Concurrent treatment: None PSYCHOLOGICAL THERAPY 1 Type: Behaviour therapy Individual/group: Individual Manualised: Yes Delivered by: Licensed psychologists, physicians or psychiatrists Length of sessions: 1 hour Number of sessions: 10 Length of intervention: 10 weeks How many sessions actually attended: Not stated Was it intended as intervention or control: Intervention Concurrent treatment: None PSYCHOLOGICAL THERAPY 2 Type: Short term therapy (psychodynamic) Individual/group:Individual Manualised: No Delivered by: Licensed psychologists, physicians or psychiatrists Length of sessions: 1 hour Number of sessions: 10 Length of intervention: 10 weeks How many sessions actually attended: Not stated Was it intended as intervention or control: Intervention Concurrent treatment: None
Outcomes	1) Depression: Depression Adjective Check List (Lubin, 1965) (self rated) 2) Depression: Beck Depression Inventory (self rated) 3) Depression/functioning (cognitive, coping, personal activity, social, somatic indicators, mood, overall general satisfaction): Author devised measure (self rated) 4) Complaint: Average complaint rating (self rated) 5) Goal attainment: Average goal attainment (self rated) 6) Dropouts
Notes	No SDs present for post and follow‐up scores, therefore pre‐intervention SDs used.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B ‐ Unclear

Murphy 1995

Methods	Was allocation sequence adequately generated: Yes Was allocation adequately concealed: No Were interventions blinded to participant/provider: Not possible Were outcome assessors blinded: Not possible for self‐rated, no for clinician rated Were drop outs adequately described: Unclear (number of dropouts per group described, but not the reasons for dropout) Was ITT analysis undertaken: Yes for continuous measures, no for dichotomous Did authors report on all a‐priori outcomes: No Other: Patients told their treatment assignment before undertaking the full assessment battery; > 50% of patients assigned to antidepressants either refused the assignment or dropped out of treatment Number randomised: 37 Number dropped out (relaxation): 3 Number dropped out (CBT): 0 Number dropped out (antidepressants): 5
Participants	Primary or Secondary depression: Primary How was depression defined: Diagnosis using Feighner et al (1972) research criteria for unipolar affective disorder, depressed and cut‐off on depression scales: BDI>= 14, HRSD >= 10, Setting: Community Severity (relaxation): BDI 24.69, HRSD 15.53 Severity (CBT): BDI 24.73, HRSD 15.73 Severity (antidepressants): BDI 25.60, HRSD 16.40 Age (relaxation): 40.7 Age (CBT): 39.8 Age (antidepressants): 37.6 Sex (relaxation): M: 1 (7.1%), F: 13 (92.9%) Sex (CBT): M: 3 (27.3%), F: 8 (72.7%) Sex (antidepressants): M: 7 (58.3%), F: 5 (41.7%) Ethnicity (relaxation):100% white Ethnicity (CBT): 91% white, 9% black Ethnicity (antidepressants): 100% white Suicidality: not stated Comorbid anxiety: not stated Psychiatric comorbidity (relaxation): 8 anxiety disorder Psychiatric comorbidity (CBT): 7 anxiety disorder Psychiatric comorbidity (antidepressants): 8 anxiety disorder Recruitment strategy: News releases Country: USA Criteria for trial entry: Aged between 18 and 60, free from major medical disease or medication that would be incompatible with antidepressants, free from other Axis I or II psychiatric disorders other than anxiety, willing to accept random treatment assignment and participation in treatment and assessment, not taking psychotropic medications
Interventions	RELAXATION Type of relaxation: Jacobson or derivative Individual/group: Individual Manualised: Yes Delivered by: 3 psychologists and a social worker, also self for homework Length of sessions: 50 minutes (plus 20 minute relaxation tape daily) Number of sessions: max of 20 Length of intervention: 16 weeks How many sessions actually attended: mean 15.0, homework compliance not reported Was it intended as intervention or control: Control Concurrent treatment: None PSYCHOLOGICAL THERAPY Type: Cognitive behaviour therapy Individual/group: Individual Manualised: No Delivered by: 3 psychologists Length of sessions: 50 minutes Number of sessions: max of 20 Length of intervention: 16 weeks How many sessions actually attended: 16.6 Was it intended as intervention or control: Intervention Concurrent treatment: None ANTIDEPRESSANTS Type: Tricyclic: Desipramine Dosage/regimen of pharmacotherapy: daily dose increased to 150‐300 mg/day Length of pharmacotherapy: 16 weeks Length of sessions: 20 minutes weekly with psychiatrist (no supportive therapy) for 4 weeks, then weekly or biweekly for 12 weeks How much medication received: highly variable Concurrent treatment: None
Outcomes	1) Depression: Beck Depression Inventory (self rated) 2) Depression: Hamilton Rating Scale for Depression (HRSD‐17) (clinician rated) 3) Self control: Self‐control Scale (Rosenbaum, 1980) (self rated) 4) Belief in efficacy of assigned treatment: Author devised measure (self rated) 5) Satisfaction with treatment: Author devised measure (self rated)
Notes	Used "response" defined as 50% reduction on clinician rated scale, and "recovery" defined as <=9 on self‐rated scale (BDI)
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	High risk	C ‐ Inadequate

Pace 1977a

Methods	Was allocation sequence adequately generated: Unclear Was allocation adequately concealed: Unclear Were interventions blinded to participant/provider: Not possible Were outcome assessors blinded: Not possible for self‐rated Were drop outs adequately described: Yes Was ITT analysis undertaken: No Did authors report on all a‐priori outcomes: Yes Other: Number randomised: 18 Number dropped out (relaxation): 1 during intervention, 1 during follow‐up Number dropped out (SAT): 0 during intervention, 1 during follow‐up Number dropped out (CET): 1 during intervention, 1 during follow‐up
Participants	Primary or Secondary depression: Primary How was depression defined: Cut‐off on depression scales: BDI>20 Setting: University Severity (relaxation): BDI 35.5 Severity (SAT): BDI 27.3 Severity (CET): BDI 30.2 Age (relaxation): 32.6 Age (SAT): 47.6 Age (CET): 35.0 Sex (overall): F: 18 (100%) Ethnicity: not stated Suicidality: not stated Comorbid anxiety (overall): STAI 53.6 Psychiatric comorbidity: not stated Recruitment strategy: Public advertisement Country: Australia Criteria for trial entry: Aged 20 to 55, BDI>20, been depressed for at least 2 months, not taking antidepressants up to within one month prior, not received professional advice for depression within two months prior, absence of excessive alcohol consumption, sexual disorders, mania, hysteria, schizophrenia, physical illnesses.
Interventions	RELAXATION Type of relaxation: Progressive muscle relaxation Individual/group: Individual Manualised: Yes Delivered by: 2 psychology therapists Length of sessions: 1 hour Number of sessions: 7 Length of intervention: 3.5 weeks How many sessions actually attended: Not stated Was it intended as intervention or control: Intervention Concurrent treatment: None PSYCHOLOGICAL THERAPY Type: Sensory Awareness Training (SAT) Individual/group: Individual Manualised: Yes Delivered by: 2 psychology therapists Length of sessions: 1 hour Number of sessions: 7 Length of intervention: 3.5 weeks How many sessions actually attended: not stated Was it intended as intervention or control: Intervention Concurrent treatment: None PSYCHOLOGICAL THERAPY Type: Cognitive‐Emotional Therapy (CET) Individual/group: Individual Manualised: Yes Delivered by: 2 psychology therapists Length of sessions: 1 hour Number of sessions: 7 Length of intervention: 3.5 weeks How many sessions actually attended: not stated Was it intended as intervention or control: Control Concurrent treatment: None
Outcomes	1) Depression: Zung Self‐Rated Depression Scale (self rated) (Zung, 1965) 2) Depression: Depression Adjective Checklists (DACL) (self rated) (Lubin, 1967) 3) Depression: Sentence Completions Method, abbreviated version (self rated) (Rohdes, 1957) 4) Sleep disturbance: Author devised sleep measure 5) Anxiety: State Trait Anxiety Inventory (STAI) (Spielberger et al, 1970) 6) Psychomotor performance: Block Design of Wechsler Adult Intelligence Scale (Wechsler, 1955) 7) Appearance‐responsiveness: the DACL and a 10‐point rating scale of depression completed by two observers 8) Decision making: Number of items completed in 10 minutes from Edwards Personal Preference Schedule (Edwards, 1954) 9) Test‐taking performance: Tester's ratings of subjects on 8 scales
Notes	Reported as study 2
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B ‐ Unclear

Pace 1977b

Methods	Was allocation sequence adequately generated: Unclear Was allocation adequately concealed: Unclear Were interventions blinded to participant/provider: Not possible Were outcome assessors blinded: Not possible for self‐rated Were drop outs adequately described: Yes Was ITT analysis undertaken: No Did authors report on all a‐priori outcomes: Yes Other: Wait‐list group was not randomly assigned and thus we did not extract data from it. Number randomised: 24 Number dropped out (relaxation): 1 during intervention, 0 during follow‐up Number dropped out (TA): 1 during intervention, 0 during follow‐up Number dropped out (CT): 2 during intervention, 1 during follow‐up
Participants	Primary or Secondary depression: Primary How was depression defined: Cut‐off on depression scales: BDI>20 (3 week version) Setting: University Severity (relaxation): BDI 25.7 Severity (TA): BDI 25.8 Severity (CT): BDI 25.8 Age (relaxation): 36.0 Age (TA): 42.2 Age (CT): 42.8 Sex (overall): F: 24 (100%) Ethnicity: not stated Suicidality: not stated Comorbid anxiety: not stated Psychiatric comorbidity: not stated Recruitment strategy: Public advertisement Country: Australia Criteria for trial entry: Females aged 20 to 55, BDI>20, been depressed for at least 2 months, no history of phobic‐anxiety states, not taking antidepressants up to within one month prior, not received professional advice for depression within two months prior, absence of excessive alcohol consumption, sexual disorders, mania, hysteria, schizophrenia, physical illnesses.
Interventions	RELAXATION Type of relaxation: Progressive muscle relaxation Individual/group: Individual Manualised: Yes Delivered by: 3 psychology therapists Length of sessions: 1 hour Number of sessions: 7 Length of intervention: 3.5 weeks How many sessions actually attended: Not stated Was it intended as intervention or control: Intervention Concurrent treatment: None PSYCHOLOGICAL THERAPY Type: Task assignment Individual/group: Individual Manualised: Yes Delivered by: 3 psychology therapists Length of sessions: 1 hour Number of sessions: 7 Length of intervention: 3.5 weeks How many sessions actually attended: not stated Was it intended as intervention or control: Intervention Concurrent treatment: None PSYCHOLOGICAL THERAPY Type: Client‐oriented therapy (CT) Individual/group: Individual Manualised: Yes Delivered by: 2 psychology therapists Length of sessions: 1 hour Number of sessions: 7 Length of intervention: 3.5 weeks How many sessions actually attended: not stated Was it intended as intervention or control: Control Concurrent treatment: None
Outcomes	1) Depression: Beck Depression Inventory (BDI) (self rated) (Beck et al, 1961) 2) Depression: Depression Adjective Checklists (DACL) (self rated) (Lubin, 1967) 3) Depression: Sentence Completions Method, abbreviated version (self rated) (Rohdes, 1957) 4) Sleep disturbance: Author devised sleep measure 5) Anxiety: State Trait Anxiety Inventory (STAI) (Spielberger et al, 1970) 6) Self‐expression: Rathus Assertiveness Scale (RAS) (Rathus, 1973)7) Activity level and obtained reinforcement: Pleasant Events Form (PEF) (author devised)
Notes	Reported as study 3. Study also included a wait‐list arm which did not have random assignment.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B ‐ Unclear

Reynolds 1986

Methods	Was allocation sequence adequately generated: Unclear Was allocation adequately concealed: Unclear Were interventions blinded to participant/provider: Not possible Were outcome assessors blinded: Not possible for self‐rated, unclear for clinician rated Were drop outs adequately described: Yes Was ITT analysis undertaken: No Did authors report on all a‐priori outcomes: Yes Other: Due to a scheduling conflict, one subject originally assigned to the CBT condition was reassigned to the relaxation condition before receiving any treatment: unclear if baseline data includes this participant's data in the CBT or relaxation group. Although an initial BID score of 20 or greater was required for inclusion, 2 subjects with scores of 18 who met all other criteria were included. Number randomised: 30 Number dropped out (relaxation): 3 during intervention, 2 during follow‐up Number dropped out (CBT): 3 during intervention, 0 during follow‐up Number dropped out (control): 0 during intervention, 1 during follow‐up
Participants	Primary or Secondary depression: Primary How was depression defined: Cut‐off on depression scales: BDI?12, RADS?72, BID?20 Setting: School Severity (relaxation): BDI 17.1 Severity (CBT): BDI 21.1 Severity (control): BDI 16.9 Age (overall): 15.65 Sex (overall): M: 11 (36.7%), F: 19 (63.3%) Ethnicity (overall): "white" Suicidality: not stated Comorbid anxiety (relaxation): STAI: 50.50 Comorbid anxiety (CBT): STAI: 57.33 Comorbid anxiety (control): STAI: 52.11 Psychiatric comorbidity: not stated Recruitment strategy: Multiple stage screening process at a high school to obtain a high risk sample Country: USA Criteria for trial entry: No current use of medication for depression or related disorder, willingness to participate, no learning disabilities, no emotional disturbances (other than affective disorders), no mental retardation
Interventions	RELAXATION Type of relaxation: Progressive muscle relaxation Individual/group: Group Manualised: Unclear Delivered by: Therapist Length of sessions: 50 minutes Number of sessions: 10 Length of intervention: 5 weeks How many sessions actually attended: 8.25 (range 5‐10) sessions Was it intended as intervention or control: Intervention Concurrent treatment: None PSYCHOLOGICAL THERAPY Type: CBT Individual/group: Group Manualised: Yes Delivered by: Therapist Length of sessions: 50 minutes Number of sessions: 10 Length of intervention: 5 weeks How many sessions actually attended: 8.16 (range 6‐10) sessions Was it intended as intervention or control: Intervention Concurrent treatment: None WAITLIST CONTROL Manualised: initial information session Length: waited for 10 weeks and participated in all assessments
Outcomes	1) Depression:RADS (Reynolds, 1986) (self report) 2) Depression: Modified BDI (Beck et al, 1961) (self report) 3) Depression: Interviews using the Bellevue Index of Depression (BID) (Petti, 1978) 4) Self concept: Rosenberg Self esteem Scale (RSES) (Rosenberg, 1965) 5) Anxiety: State Trait Anxiety Inventory (STAI)(Spielberger et al, 1970)
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B ‐ Unclear

Sonis 1987

Methods	Was allocation sequence adequately generated: Unclear Was allocation adequately concealed: Unclear Were interventions blinded to participant/provider: Not possible Were outcome assessors blinded: Not possible for self‐rated, unclear for clinician rated Were drop outs adequately described: No Was ITT analysis undertaken: Unclear Did authors report on all a‐priori outcomes: No, only describe CDRS‐R Other: Small N's. This is a cross over trial with several issues: 1) no description of how many participants were included in each intervention in each arm (i.e. not clear what the order of cross over was). 2) A cross over trial may be a questionable design in a disorder which is naturally remitting i.e. those who receive the interventions in the second phase may be experiencing a less severe disorder by the time the second phase is undertaken. 3) Unclear if a washout phase is appropriate in a naturally remitting disorder for the same reason. 4) No cross over carry over effects are reported. 5) Overall, due to reporting, no pure relaxation effect can be pulled out. Post hoc division of CDRS into 3 domains. Number randomised: 9 (with depression) Number dropped out: not stated
Participants	Primary or Secondary depression: Primary (NOTE: only 9 had a depressive disorder, 5 had no diagnosis, 5 had ADD) How was depression defined: Diagnosis by Diagnostic Interview for Children & Adolescents (DICA) or Diagnostic Interview for Parents of Children & Adolescents (DICA‐P) for DSM‐III criteria; initial assessment also included the Children's Depression Rating Scale (CDRS‐R), several self‐report scales including the Children's Seasonal Symptom Checklist (SSCL‐C, Sonis et al 1985) and the BDI, and several parent report measures including the revised Children's Behaviour Checklist (CBCL, Achenbach & Endelbrock 1983) and the Children's Seasonal Symptom Checklist for Parents (SSCL‐P Sonis et al 1985). Setting: Study investigator located in university department. Interventions took place in the home Severity (overall): For MDD & SD combined 61.25 on the CDRS‐R Age (overall): Child/adolescent ‐ actual age not reported Sex (overall): M: 3 (33.3%), F: 6 (66.6%) Ethnicity: not stated Suicidality: not stated Comorbid anxiety: not stated Psychiatric comorbidity: not stated Recruitment strategy: Media Country: USA Criteria for trial entry: Everyone who answered the advertisement (which included some who were not depressed), no mental retardation IQ<70, no chronic medical conditions, not using medication that could affect cognition and/or mood, no ophthalmologic abnormalities
Interventions	RELAXATION Type of relaxation: Relaxation imagery Individual/group: Individual Manualised: Yes ‐ self selected tape followed by reading or homework for a total of 1 hour 45 minutes Delivered by: Self by tape Length of sessions: 15 minutes Number of sessions: 6 Length of intervention: 1 week then 2 day washout How many sessions actually attended: Not stated Was it intended as intervention or control: Intervention Concurrent treatment: None LIGHT TREATMENT Type: Self exposure to 2500 lux of full spectrum light, instructions to sit 3 feet from light, glance at light once a minute Individual/group: Individual Manualised: Yes Delivered by: Self Length of sessions: 2 hours Number of sessions: 6 Length of intervention: 1 week then 2 day washout How many sessions actually attended: Not stated Was it intended as intervention or control: Intervention Concurrent treatment: None
Outcomes	1) Depression: Children's depression rating scale (CDRS‐R) (Poznanski et al, 1984) (clinician rated) 2) Depression: Beck Depression Inventory (BDI) (Beck, 1972) (self rated) 3) Depression: Global Improvement Scale (GIS, Gittleman, 1984)
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B ‐ Unclear

Wilson 1982

Methods	Was allocation sequence adequately generated: Unclear Was allocation adequately concealed: Unclear Were interventions blinded to participant/provider: Not possible Were outcome assessors blinded: Not possible for self‐rated, yes for clinician rated Were drop outs adequately described: No Was ITT analysis undertaken: No Did authors report on all a‐priori outcomes: Yes Other: During the follow‐up period there were significantly more subjects in the minimal contact group who received additional treatment than subjects in the other two conditions Number randomised: 97 Number dropped out (overall): 33 during intervention (no breakdown of groups given) Number dropped out (relaxation+placebo): 0 during follow‐up Number dropped out (psychological therapy+placebo): 1 during follow‐up Number dropped out (minimal contact+placebo) 1 during follow‐up
Participants	Primary or Secondary depression: Primary How was depression defined: Cut‐off score on depression scale, BDI >= 20 Setting: Community Severity (psychological therapy+placebo): BDI 27.22 Severity (minimal contact+placebo): BDI 25.00 Age (overall): 38.8 Sex (overall): M: 22(34.4%), F: 42 (65.6%) Ethnicity: not stated Suicidality: not stated Comorbid anxiety (relaxation+placebo): Anxiety Scale: 30.36 Comorbid anxiety (psychological therapy+placebo): Anxiety Scale: 31.33 Comorbid anxiety (minimal contact+placebo): Anxiety Scale: 27.33 Psychiatric comorbidity: not stated Recruitment strategy: Media Country: Australia Criteria for trial entry: Aged between 20 and 55, not in receipt of psychological or pharmacological treatment (except minor tranquillizers), self‐reported duration of depression for at least 2 months, absence of other major disorders (psychosis, manic‐depressive disorders, addictions, OCD, severe phobic states), no contra‐indications for the use of antidepressant amitriptyline
Interventions	RELAXATION Type of relaxation: Progressive muscle relaxation, closely following Bernstein & Borkovec (1973) Individual/group: Individual Manualised: Yes Delivered by: 3 graduate students in psychology and self for homework Length of sessions: 1 hour (40 minutes spent on relaxation), 30 minute daily practice encouraged Number of sessions: 7 Length of intervention: 2 months How many sessions actually attended: Not stated for therapist sessions, home practice attended on average for approx. 30 minutes on 6 out of 7 days Was it intended as intervention or control: Intervention Concurrent treatment: Antidepressant placebo. Half of the subjects also received a 25 min. tape recording at end of treatment, to be used at home at least once a fortnight until follow‐up PSYCHOLOGICAL THERAPY Type: Task assignment, designed to increase frequency, quality and range of activities and social interactions Individual/group: Individual Manualised: Yes Delivered by: Three graduate students in psychology Length of sessions: 1 hour Number of sessions: 7 Length of intervention: 2 months How many sessions actually attended: Not stated Was it intended as intervention or control: Intervention Concurrent treatment: Antidepressant placebo. Half of the subjects also received a 25 min. tape recording at end of treatment, to be used at home at least once a fortnight until follow‐up MINIMAL CONTACT Type: Non‐directive therapy coinciding with supply of medication Individual/group: Individual Manualised: No Delivered by: Three graduate students in psychology Length of sessions: 1 hour Number of sessions: 2 Length of intervention: 2 months How many sessions actually delivered: Not stated Was it intended as intervention or control: Control Concurrent treatment: Antidepressant placebo. Half of the subjects also received a 25 min. tape recording at end of treatment, to be used at home at least once a fortnight until follow‐up
Outcomes	1) Depression: BDI (Beck et al, 1961) (self rated) 2) Depression and anxiety: Depression and Anxiety Scales (Lovibond, 1981) (self rated) 3) Depression (unobtrusive): Sentence Completion Test (Pace, 1977) 4) Phobic symptomatology: Modified version of Fear Survey Schedule II (Geer, 1965) (self rated) 5) Sleep quality: Sleep questionnaire (author devised) (self rated) 6) Positive reinforcement / activity frequency: Pleasant Events Schedule (self rated)
Notes	There was also another treatment arm where each of the three treatment conditions (relaxation, psychological therapy, minimal contact) concurrently took an antidepressant, rather than placebo
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B ‐ Unclear

Wood 1996

Methods	Was allocation sequence adequately generated: Unclear Was allocation adequately concealed: Unclear Were interventions blinded to participant/provider: Not possible Were outcome assessors blinded: Not possible for self‐rated, unclear for clinician rated Were drop outs adequately described: Yes Was ITT analysis undertaken: Yes Did authors report on all a‐priori outcomes: Yes Number randomised: 53 Number dropped out (relaxation): 3 during intervention, 2 during 3 month follow up, 12 during 3‐6 month follow‐up Number dropped out (DTP): 2 during intervention, 2 during 3 month follow‐up, 0 during 3‐6 month follow‐up
Participants	Primary or Secondary depression: Primary How was depression defined: Diagnosis using KSADS for a DSM‐III‐R diagnosis or RCD diagnosis of minor depression plus cut‐off on depression scale MFQ > 15 Setting: Unclear ‐ might assume outpatient at the children's hospital where they were recruited Severity (relaxation): MFQ ‐ parent report 28.7 (11.6) Severity (DTP): MFQ ‐ parent report 25.8 (9.8) Age (relaxation): 14.6 (1.6) Age (DTP): 13.8 (1.7) Sex (relaxation): M: 7 (29%), F: 17 (71% F) Sex (DTP): M: 8 (33%), F: 16 (67%) Ethnicity: not stated Suicidality: most suicidal Comorbid anxiety: not stated Psychiatric comorbidity (relaxation): 7 conduct disorder, 14 overanxious Psychiatric comorbidity (DTP): 4 conduct disorder, 13 overanxious Recruitment strategy: Consecutive outpatient clinic referrals Country: UK Criteria for trial entry: 9‐17 years, no other psychiatric disorder, not an inpatient, not taking or likely to take antidepressants, able to complete questionnaires, not autistic, not attending special school for learning problems, no major physical illness or epilepsy
Interventions	RELAXATION Type of relaxation: Progressive muscle relaxation based on Bernstein & Borkoves (1973) Individual/group: Unclear, but assume individual Manualised: Yes Delivered by: Therapists Length of sessions: Unclear Number of sessions: 5‐8 Length of intervention: Unclear How many sessions actually attended: 6.2 Was it intended as intervention or control: Control Concurrent treatment: None PSYCHOLOGICAL THERAPY Type: DTP ‐ Depression Treatment Program (called a brief CBT intervention) which targets negative thinking, social relationships problems and symptoms such as sleeping difficulties and inactivity Individual/group: Individual Manualised: Yes Delivered by: Therapists who trained on at least 5 cases with supervision from a psychologist experienced in CBT before the trial and had 3 years experience in child psychiatry Length of sessions: Unclear Number of sessions: 5‐8 Length of intervention: Unclear How many sessions actually attended: 6.4 Was it intended as intervention or control: Intervention Concurrent treatment: None
Outcomes	1) Depression: Mood and Feelings Questionnaire (MFQ) (Angold et al, 1987) (self report) 2) Depression: Depression scale of the K‐SADS (clinician rated) 3) Anxiety: Revised Children's Manifest Anxiety Scale (RCMAS) (Reynolds & Richmond, 1978) ‐ child and parent 4) Self esteem: Warr and Jackson Scale (1985) Child and Parent 5) Conduct problems: Antisocial Behaviour Problems (ABS) (Olwevs, 1989) Child and Parent 6) Expectancy of treatment: Likert Scale (Marks, 1981) 7) Satisfaction: Likert Scale (Marks, 1981) 8) Clinical state: Clinical Global Improvement Scale (CGI) (clinician rated) 9) Functioning: GAS (Global Assessment Scale) (Shaffer et al, 1983) (clinician rated)
Notes	SE for MFQ estimated from Figure1. SDs imputed from SEs.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B ‐ Unclear

Characteristics of excluded studies [ordered by study ID]

Ir a:

estudios incluidos
estudios en curso

Study	Reason for exclusion
Broota 1990	Depression symptoms not measured on a validated, reliable depression symptom scale
Brown 1997	Non randomised study
Contreras 2006	Relaxation intervention was part of a CBT package
Corrado 1999	Participants not selected for diagnosed depression or high depression symptom score
DeBerry 1982	Participants not selected for diagnosed depression or high depression symptom score
DeBerry 1989	Participants not selected for diagnosed depression or high depression symptom score
DeVaney 1991	Participants not selected for diagnosed depression or high depression symptom score
Field 1998	Inadequate relaxation intervention
Goodwin 2004	Participants not selected for diagnosed depression or high depression symptom score
Halonen 1985	Participants not selected for diagnosed depression or high depression symptom score
Holland 1991	Participants had comorbid anxiety.
Keyes 1991	Participants not selected for diagnosed depression or high depression symptom score
Kirkpatrick 1977	Non randomised study
Klein 1985	Relaxation intervention based on yoga and meditation
Knubben 2007	Inadequate relaxation intervention
Krishnamurthy 2007	Relaxation intervention was based on yoga and participants not selected for diagnosed depression or high depression symptom score
Leppamaki 2002	Participants not selected for diagnosed depression or high depression symptom score
Leppamaki 2004	Participants not selected for diagnosed depression or high depression symptom score
Lolak 2005	Participants not selected for diagnosed depression or high depression symptom score
Maher 2002	Relaxation intervention arm was dropped from the trial
Parandeh 2006	Participants not selected for diagnosed depression or high depression symptom score
Partonen 1998	Participants not selected for diagnosed depression or high depression symptom score
Petersen 2002	Relaxation included as part of a broader intervention (counselling).
Richards 1988	Participants not selected for diagnosed depression or high depression symptom score
Roth 1987	Participants not selected for diagnosed depression or high depression symptom score
Shaw 1994	Participants not selected for diagnosed depression or high depression symptom score
Sloan 1981	Non randomised study
Sloman 2002	Participants not selected for diagnosed depression or high depression symptom score
Swenson 1986	Relaxation intervention based on hypnosis.
Warren 1995	Participants not selected for diagnosed depression or high depression symptom score
Watts 1988	Depression not measured as an outcome
Wetzel 1992	Data on relaxation group not presented

Characteristics of ongoing studies [ordered by study ID]

Ir a:

estudios incluidos
estudios excluidos

Baillon 2003

Trial name or title	Pilot study of the short‐term effects of a multi‐sensory environment (MSE) on elderly patients suffering from depression
Methods
Participants	Primary or Secondary depression: Primary How was depression defined: Diagnosis of depressive illness Country: UK Criteria for trial entry: Aged 65+, capacity to give consent, and no organic brain syndrome, significant hearing impairment, significant sight impairment, suicidal ideation, ECT during course of trial, evidence of delirium or change in medication that will trigger withdrawal
Interventions	RELAXATION Two individual relaxation sessions over one week, intended as a control MULTI‐SENSORY ENVIRONMENT (MSE) Two individual sessions in the MSE over one week, intended as intervention
Outcomes	Hospital Anxiety and Depression Scale (HADS) Beck Depression Inventory Visual Analog Scales of Mood Heart rate monitoring
Starting date	1 September 2003
Contact information	Sarah Baillon Research Fellow Psychiatry for the Elderly University Department of Health Sciences Leicester General Hospital Gwendolen Road Leicester LE5 4PW United Kingdom email: [email protected]
Notes

Krogh 2007

Trial name or title	The DEMO trial: A randomized, parallel‐group, observer‐blinded clinical trial of aerobic versus non‐aerobic versus relaxation training for patients with light to moderate depression
Methods
Participants	Primary or Secondary depression: Primary How was depression defined: Diagnosis of depressive illness Recruitment strategy: Physicians and the public informed through open meetings, newspapers, leaflets and television. Referrals from general practitioners, private practicing psychiatrists, psychologists, and psychiatric wards Setting: Community Country: Denmark Criteria for trial entry: Age 18‐55 years; living in the vicinity of Copenhagen; depression (F32.0, F32.1, F33.0, ICD‐10 verified F33.1); fluent in Danish; able to read and understand informed consent; no current substance or recreational drug abuse; no contraindications to physical exercise; not exercising more than 1 hour a week; no sick leave longer than 24 months; no suicidal behavior (<=2 on HAM‐D17 item 3); not in early retirement
Interventions	RELAXATION Type of relaxation: Combination of stretches, massage, balance exercises and progressive muscle relaxation exercises Individual/group: Group Manualised: Yes Delivered by: Highly qualified physiotherapists Length of sessions: 1.5 hours Number of sessions: 2 per week Length of intervention: 4 months Was it intended as intervention or control: Control Concurrent treatment: Some patients may be taking antidepressants EXERCISE Type: Aerobic exercise Individual/group: Group Manualised: Yes Delivered by: Highly qualified physiotherapists Length of sessions: 1.5 hours Number of sessions: 2 per week Length of intervention: 4 months Was it intended as intervention or control: Intervention Concurrent treatment: Some patients may be taking antidepressants EXERCISE Type: Non‐aerobic exercise Individual/group: Group Manualised: Yes Delivered by: Highly qualified physiotherapists Length of sessions: 1.5 hours Number of sessions: 2 per week Length of intervention: 4 months Was it intended as intervention or control: Intervention Concurrent treatment: Some patients may be taking antidepressants
Outcomes	1) Depression: Hamilton Depression Scale‐17 (clinician rated), Beck Depression Inventory II (self rated), Montgomery‐Asberg Depression Rating Scale (self‐rated) 2) Anxiety: Hamilton Anxiety Scale 3) Psychopathology: Symptom Checklist (SCL‐92) Quality of Life: WHO‐5 Lost days from work: Lost days from work during last 10 working days Verbal intelligence: Danish Adult Reading Test Attention: Digit Span (WAIS), Subtracting Serial Sevens Visuomotor speed: Trail Making part A and B, Digit Symbol Test (WAIS‐R) Language: Verbal Fluency S and Animals Memory: Buschke Selective Reminding Test, Rey Complex Figure Test Biochemistry: cortisol, prolactin Physical activity: Physical activity during work and leisure questionnaire by Saltin & Grimsby (1968)
Starting date	February 2005
Contact information	Jesper Krogh Psychiatric Department E, Bispebjerg Hospital, Copenhagen University Hospital, DK‐2400, Copenhagen, Denmark [email protected]
Notes

Data and analyses

Open in table viewer

Comparison 1. Relaxation versus wait‐list, no treatment or minimal treatment

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Depression scores ‐ self rated post intervention Show forest plot	5	136	Std. Mean Difference (IV, Fixed, 95% CI)	‐0.59 [‐0.94, ‐0.24]
Open in figure viewer Analysis 1.1 Comparison 1 Relaxation versus wait‐list, no treatment or minimal treatment, Outcome 1 Depression scores ‐ self rated post intervention.
2 Depression scores ‐ self rated follow‐up (short‐term) Show forest plot	2	48	Std. Mean Difference (IV, Fixed, 95% CI)	‐0.74 [‐1.34, ‐0.15]
Open in figure viewer Analysis 1.2 Comparison 1 Relaxation versus wait‐list, no treatment or minimal treatment, Outcome 2 Depression scores ‐ self rated follow‐up (short‐term).
3 Depression scores ‐ self rated follow‐up (long‐term) Show forest plot	1		Std. Mean Difference (IV, Fixed, 95% CI)	Subtotals only
Open in figure viewer Analysis 1.3 Comparison 1 Relaxation versus wait‐list, no treatment or minimal treatment, Outcome 3 Depression scores ‐ self rated follow‐up (long‐term).
4 Depression scores ‐ clinician rated post intervention Show forest plot	2	52	Std. Mean Difference (IV, Random, 95% CI)	‐1.35 [‐3.06, 0.37]
Open in figure viewer Analysis 1.4 Comparison 1 Relaxation versus wait‐list, no treatment or minimal treatment, Outcome 4 Depression scores ‐ clinician rated post intervention.
5 Depression scores ‐ clinician rated follow‐up (short‐term) Show forest plot	1		Std. Mean Difference (IV, Fixed, 95% CI)	Subtotals only
Open in figure viewer Analysis 1.5 Comparison 1 Relaxation versus wait‐list, no treatment or minimal treatment, Outcome 5 Depression scores ‐ clinician rated follow‐up (short‐term).
6 Non response/remission ‐ self rated post intervention Show forest plot	2	52	Risk Ratio (M‐H, Fixed, 95% CI)	0.28 [0.14, 0.54]
Open in figure viewer Analysis 1.6 Comparison 1 Relaxation versus wait‐list, no treatment or minimal treatment, Outcome 6 Non response/remission ‐ self rated post intervention.
7 Non response/remission ‐ self rated follow‐up (short‐term) Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only
Open in figure viewer Analysis 1.7 Comparison 1 Relaxation versus wait‐list, no treatment or minimal treatment, Outcome 7 Non response/remission ‐ self rated follow‐up (short‐term).
8 Non response/remission ‐ clinician rated post intervention Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only
Open in figure viewer Analysis 1.8 Comparison 1 Relaxation versus wait‐list, no treatment or minimal treatment, Outcome 8 Non response/remission ‐ clinician rated post intervention.
9 Dropouts during intervention Show forest plot	4	122	Risk Ratio (M‐H, Random, 95% CI)	0.72 [0.08, 6.73]
Open in figure viewer Analysis 1.9 Comparison 1 Relaxation versus wait‐list, no treatment or minimal treatment, Outcome 9 Dropouts during intervention.
10 Dropouts during follow‐up (short‐term) Show forest plot	2	54	Risk Ratio (M‐H, Fixed, 95% CI)	1.0 [0.19, 5.29]
Open in figure viewer Analysis 1.10 Comparison 1 Relaxation versus wait‐list, no treatment or minimal treatment, Outcome 10 Dropouts during follow‐up (short‐term).
11 Dropouts during follow‐up (long‐term) Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only
Open in figure viewer Analysis 1.11 Comparison 1 Relaxation versus wait‐list, no treatment or minimal treatment, Outcome 11 Dropouts during follow‐up (long‐term).

Open in table viewer

Comparison 2. Relaxation versus psychological treatment

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Depression scores ‐ self rated post intervention Show forest plot	9	286	Std. Mean Difference (IV, Fixed, 95% CI)	0.38 [0.14, 0.62]
Open in figure viewer Analysis 2.1 Comparison 2 Relaxation versus psychological treatment, Outcome 1 Depression scores ‐ self rated post intervention.
2 Depression scores ‐ self rated follow‐up (short‐term) Show forest plot	6	192	Std. Mean Difference (IV, Fixed, 95% CI)	0.36 [0.07, 0.65]
Open in figure viewer Analysis 2.2 Comparison 2 Relaxation versus psychological treatment, Outcome 2 Depression scores ‐ self rated follow‐up (short‐term).
3 Depression scores ‐ self rated follow‐up (long‐term) Show forest plot	2	62	Std. Mean Difference (IV, Fixed, 95% CI)	0.11 [‐0.39, 0.61]
Open in figure viewer Analysis 2.3 Comparison 2 Relaxation versus psychological treatment, Outcome 3 Depression scores ‐ self rated follow‐up (long‐term).
4 Depression scores ‐ clinician rated post intervention Show forest plot	3	72	Std. Mean Difference (IV, Fixed, 95% CI)	0.29 [‐0.18, 0.75]
Open in figure viewer Analysis 2.4 Comparison 2 Relaxation versus psychological treatment, Outcome 4 Depression scores ‐ clinician rated post intervention.
5 Depression scores ‐ clinician rated follow‐up (short‐term) Show forest plot	1		Std. Mean Difference (IV, Fixed, 95% CI)	Subtotals only
Open in figure viewer Analysis 2.5 Comparison 2 Relaxation versus psychological treatment, Outcome 5 Depression scores ‐ clinician rated follow‐up (short‐term).
6 Non response/remission ‐ self rated post intervention Show forest plot	5	203	Risk Ratio (M‐H, Fixed, 95% CI)	1.71 [1.25, 2.34]
Open in figure viewer Analysis 2.6 Comparison 2 Relaxation versus psychological treatment, Outcome 6 Non response/remission ‐ self rated post intervention.
7 Non response/remission ‐ self rated follow‐up (short‐term) Show forest plot	3	89	Risk Ratio (M‐H, Fixed, 95% CI)	1.88 [1.05, 3.34]
Open in figure viewer Analysis 2.7 Comparison 2 Relaxation versus psychological treatment, Outcome 7 Non response/remission ‐ self rated follow‐up (short‐term).
8 Non response/remission ‐ clinician rated post intervention Show forest plot	3	104	Risk Ratio (M‐H, Fixed, 95% CI)	1.96 [1.20, 3.22]
Open in figure viewer Analysis 2.8 Comparison 2 Relaxation versus psychological treatment, Outcome 8 Non response/remission ‐ clinician rated post intervention.
9 Non response/remission ‐ clinician rated follow‐up (short‐term) Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only
Open in figure viewer Analysis 2.9 Comparison 2 Relaxation versus psychological treatment, Outcome 9 Non response/remission ‐ clinician rated follow‐up (short‐term).
10 Dropouts during intervention Show forest plot	8	289	Risk Ratio (M‐H, Fixed, 95% CI)	1.59 [0.83, 3.05]
Open in figure viewer Analysis 2.10 Comparison 2 Relaxation versus psychological treatment, Outcome 10 Dropouts during intervention.
11 Dropouts during follow‐up (short‐term) Show forest plot	5	135	Risk Ratio (M‐H, Fixed, 95% CI)	1.54 [0.43, 5.51]
Open in figure viewer Analysis 2.11 Comparison 2 Relaxation versus psychological treatment, Outcome 11 Dropouts during follow‐up (short‐term).
12 Dropouts during follow‐up (long‐term) Show forest plot	2	73	Risk Ratio (M‐H, Random, 95% CI)	2.72 [0.03, 251.39]
Open in figure viewer Analysis 2.12 Comparison 2 Relaxation versus psychological treatment, Outcome 12 Dropouts during follow‐up (long‐term).

Open in table viewer

Comparison 3. Relaxation versus lifestyle and complementary treatments

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Depression scores ‐ self rated post intervention Show forest plot	1		Std. Mean Difference (IV, Fixed, 95% CI)	Subtotals only
Open in figure viewer Analysis 3.1 Comparison 3 Relaxation versus lifestyle and complementary treatments, Outcome 1 Depression scores ‐ self rated post intervention.
2 Dropouts during intervention Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only
Open in figure viewer Analysis 3.2 Comparison 3 Relaxation versus lifestyle and complementary treatments, Outcome 2 Dropouts during intervention.

Open in table viewer

Comparison 4. Relaxation versus medication

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Depression scores ‐ self rated post intervention Show forest plot	2	115	Std. Mean Difference (IV, Random, 95% CI)	‐0.59 [‐2.07, 0.89]
Open in figure viewer Analysis 4.1 Comparison 4 Relaxation versus medication, Outcome 1 Depression scores ‐ self rated post intervention.
2 Depression scores ‐ self rated follow‐up (short‐term) Show forest plot	1		Std. Mean Difference (IV, Fixed, 95% CI)	Subtotals only
Open in figure viewer Analysis 4.2 Comparison 4 Relaxation versus medication, Outcome 2 Depression scores ‐ self rated follow‐up (short‐term).
3 Depression scores ‐ clinician rated post intervention Show forest plot	1		Std. Mean Difference (IV, Fixed, 95% CI)	Subtotals only
Open in figure viewer Analysis 4.3 Comparison 4 Relaxation versus medication, Outcome 3 Depression scores ‐ clinician rated post intervention.
4 Non response/remission ‐ self rated post intervention Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only
Open in figure viewer Analysis 4.4 Comparison 4 Relaxation versus medication, Outcome 4 Non response/remission ‐ self rated post intervention.
5 Dropouts during intervention Show forest plot	2	127	Risk Ratio (M‐H, Fixed, 95% CI)	0.71 [0.39, 1.31]
Open in figure viewer Analysis 4.5 Comparison 4 Relaxation versus medication, Outcome 5 Dropouts during intervention.

Open in table viewer

Comparison 5. Relaxation + medication versus medication alone

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Depression scores ‐ self rated post intervention (SMD) Show forest plot	2	40	Std. Mean Difference (IV, Fixed, 95% CI)	‐0.90 [‐1.56, ‐0.24]
Open in figure viewer Analysis 5.1 Comparison 5 Relaxation + medication versus medication alone, Outcome 1 Depression scores ‐ self rated post intervention (SMD).
2 Depression scores ‐ self rated post intervention (WMD) Show forest plot	2	40	Mean Difference (IV, Fixed, 95% CI)	‐8.03 [‐13.32, ‐2.74]
Open in figure viewer Analysis 5.2 Comparison 5 Relaxation + medication versus medication alone, Outcome 2 Depression scores ‐ self rated post intervention (WMD).
3 Depression scores ‐ self rated follow‐up (long‐term, SMD) Show forest plot	1	20	Std. Mean Difference (IV, Fixed, 95% CI)	‐0.02 [‐0.90, 0.86]
Open in figure viewer Analysis 5.3 Comparison 5 Relaxation + medication versus medication alone, Outcome 3 Depression scores ‐ self rated follow‐up (long‐term, SMD).
4 Depression scores ‐ self rated follow‐up (long‐term, WMD) Show forest plot	1	20	Mean Difference (IV, Fixed, 95% CI)	‐0.20 [‐9.18, 8.78]
Open in figure viewer Analysis 5.4 Comparison 5 Relaxation + medication versus medication alone, Outcome 4 Depression scores ‐ self rated follow‐up (long‐term, WMD).
5 Depression scores ‐ clinician rated post intervention (SMD) Show forest plot	1	20	Std. Mean Difference (IV, Fixed, 95% CI)	‐0.20 [‐1.08, 0.68]
Open in figure viewer Analysis 5.5 Comparison 5 Relaxation + medication versus medication alone, Outcome 5 Depression scores ‐ clinician rated post intervention (SMD).
6 Depression scores ‐ clinician rated post intervention (WMD) Show forest plot	1	20	Mean Difference (IV, Fixed, 95% CI)	‐1.20 [‐6.23, 3.83]
Open in figure viewer Analysis 5.6 Comparison 5 Relaxation + medication versus medication alone, Outcome 6 Depression scores ‐ clinician rated post intervention (WMD).
7 Non response/remission ‐ self rated post intervention Show forest plot	1	20	Risk Ratio (M‐H, Fixed, 95% CI)	0.05 [0.00, 0.72]
Open in figure viewer Analysis 5.7 Comparison 5 Relaxation + medication versus medication alone, Outcome 7 Non response/remission ‐ self rated post intervention.
8 Non response/remission ‐ clinician rated post intervention Show forest plot	1	20	Risk Ratio (M‐H, Fixed, 95% CI)	1.13 [0.78, 1.63]
Open in figure viewer Analysis 5.8 Comparison 5 Relaxation + medication versus medication alone, Outcome 8 Non response/remission ‐ clinician rated post intervention.
9 Dropouts during intervention Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only
Open in figure viewer Analysis 5.9 Comparison 5 Relaxation + medication versus medication alone, Outcome 9 Dropouts during intervention.

Analysis 1.1

Comparison 1 Relaxation versus wait‐list, no treatment or minimal treatment, Outcome 1 Depression scores ‐ self rated post intervention.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.2

Comparison 1 Relaxation versus wait‐list, no treatment or minimal treatment, Outcome 2 Depression scores ‐ self rated follow‐up (short‐term).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.3

Comparison 1 Relaxation versus wait‐list, no treatment or minimal treatment, Outcome 3 Depression scores ‐ self rated follow‐up (long‐term).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.4

Comparison 1 Relaxation versus wait‐list, no treatment or minimal treatment, Outcome 4 Depression scores ‐ clinician rated post intervention.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.5

Comparison 1 Relaxation versus wait‐list, no treatment or minimal treatment, Outcome 5 Depression scores ‐ clinician rated follow‐up (short‐term).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.6

Comparison 1 Relaxation versus wait‐list, no treatment or minimal treatment, Outcome 6 Non response/remission ‐ self rated post intervention.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.7

Comparison 1 Relaxation versus wait‐list, no treatment or minimal treatment, Outcome 7 Non response/remission ‐ self rated follow‐up (short‐term).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.8

Comparison 1 Relaxation versus wait‐list, no treatment or minimal treatment, Outcome 8 Non response/remission ‐ clinician rated post intervention.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.9

Comparison 1 Relaxation versus wait‐list, no treatment or minimal treatment, Outcome 9 Dropouts during intervention.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.10

Comparison 1 Relaxation versus wait‐list, no treatment or minimal treatment, Outcome 10 Dropouts during follow‐up (short‐term).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.11

Comparison 1 Relaxation versus wait‐list, no treatment or minimal treatment, Outcome 11 Dropouts during follow‐up (long‐term).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.1

Comparison 2 Relaxation versus psychological treatment, Outcome 1 Depression scores ‐ self rated post intervention.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.2

Comparison 2 Relaxation versus psychological treatment, Outcome 2 Depression scores ‐ self rated follow‐up (short‐term).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.3

Comparison 2 Relaxation versus psychological treatment, Outcome 3 Depression scores ‐ self rated follow‐up (long‐term).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.4

Comparison 2 Relaxation versus psychological treatment, Outcome 4 Depression scores ‐ clinician rated post intervention.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.5

Comparison 2 Relaxation versus psychological treatment, Outcome 5 Depression scores ‐ clinician rated follow‐up (short‐term).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.6

Comparison 2 Relaxation versus psychological treatment, Outcome 6 Non response/remission ‐ self rated post intervention.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.7

Comparison 2 Relaxation versus psychological treatment, Outcome 7 Non response/remission ‐ self rated follow‐up (short‐term).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.8

Comparison 2 Relaxation versus psychological treatment, Outcome 8 Non response/remission ‐ clinician rated post intervention.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.9

Comparison 2 Relaxation versus psychological treatment, Outcome 9 Non response/remission ‐ clinician rated follow‐up (short‐term).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.10

Comparison 2 Relaxation versus psychological treatment, Outcome 10 Dropouts during intervention.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.11

Comparison 2 Relaxation versus psychological treatment, Outcome 11 Dropouts during follow‐up (short‐term).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.12

Comparison 2 Relaxation versus psychological treatment, Outcome 12 Dropouts during follow‐up (long‐term).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.1

Comparison 3 Relaxation versus lifestyle and complementary treatments, Outcome 1 Depression scores ‐ self rated post intervention.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.2

Comparison 3 Relaxation versus lifestyle and complementary treatments, Outcome 2 Dropouts during intervention.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.1

Comparison 4 Relaxation versus medication, Outcome 1 Depression scores ‐ self rated post intervention.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.2

Comparison 4 Relaxation versus medication, Outcome 2 Depression scores ‐ self rated follow‐up (short‐term).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.3

Comparison 4 Relaxation versus medication, Outcome 3 Depression scores ‐ clinician rated post intervention.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.4

Comparison 4 Relaxation versus medication, Outcome 4 Non response/remission ‐ self rated post intervention.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.5

Comparison 4 Relaxation versus medication, Outcome 5 Dropouts during intervention.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 5.1

Comparison 5 Relaxation + medication versus medication alone, Outcome 1 Depression scores ‐ self rated post intervention (SMD).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 5.2

Comparison 5 Relaxation + medication versus medication alone, Outcome 2 Depression scores ‐ self rated post intervention (WMD).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 5.3

Comparison 5 Relaxation + medication versus medication alone, Outcome 3 Depression scores ‐ self rated follow‐up (long‐term, SMD).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 5.4

Comparison 5 Relaxation + medication versus medication alone, Outcome 4 Depression scores ‐ self rated follow‐up (long‐term, WMD).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 5.5

Comparison 5 Relaxation + medication versus medication alone, Outcome 5 Depression scores ‐ clinician rated post intervention (SMD).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 5.6

Comparison 5 Relaxation + medication versus medication alone, Outcome 6 Depression scores ‐ clinician rated post intervention (WMD).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 5.7

Comparison 5 Relaxation + medication versus medication alone, Outcome 7 Non response/remission ‐ self rated post intervention.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 5.8

Comparison 5 Relaxation + medication versus medication alone, Outcome 8 Non response/remission ‐ clinician rated post intervention.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 5.9

Comparison 5 Relaxation + medication versus medication alone, Outcome 9 Dropouts during intervention.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1. Relaxation versus wait‐list, no treatment or minimal treatment

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Depression scores ‐ self rated post intervention Show forest plot	5	136	Std. Mean Difference (IV, Fixed, 95% CI)	‐0.59 [‐0.94, ‐0.24]

2 Depression scores ‐ self rated follow‐up (short‐term) Show forest plot	2	48	Std. Mean Difference (IV, Fixed, 95% CI)	‐0.74 [‐1.34, ‐0.15]

3 Depression scores ‐ self rated follow‐up (long‐term) Show forest plot	1		Std. Mean Difference (IV, Fixed, 95% CI)	Subtotals only

4 Depression scores ‐ clinician rated post intervention Show forest plot	2	52	Std. Mean Difference (IV, Random, 95% CI)	‐1.35 [‐3.06, 0.37]

5 Depression scores ‐ clinician rated follow‐up (short‐term) Show forest plot	1		Std. Mean Difference (IV, Fixed, 95% CI)	Subtotals only

6 Non response/remission ‐ self rated post intervention Show forest plot	2	52	Risk Ratio (M‐H, Fixed, 95% CI)	0.28 [0.14, 0.54]

7 Non response/remission ‐ self rated follow‐up (short‐term) Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

8 Non response/remission ‐ clinician rated post intervention Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

9 Dropouts during intervention Show forest plot	4	122	Risk Ratio (M‐H, Random, 95% CI)	0.72 [0.08, 6.73]

10 Dropouts during follow‐up (short‐term) Show forest plot	2	54	Risk Ratio (M‐H, Fixed, 95% CI)	1.0 [0.19, 5.29]

11 Dropouts during follow‐up (long‐term) Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

Comparison 1. Relaxation versus wait‐list, no treatment or minimal treatment

Ir a la tabla de la revisión

Comparison 2. Relaxation versus psychological treatment

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Depression scores ‐ self rated post intervention Show forest plot	9	286	Std. Mean Difference (IV, Fixed, 95% CI)	0.38 [0.14, 0.62]

2 Depression scores ‐ self rated follow‐up (short‐term) Show forest plot	6	192	Std. Mean Difference (IV, Fixed, 95% CI)	0.36 [0.07, 0.65]

3 Depression scores ‐ self rated follow‐up (long‐term) Show forest plot	2	62	Std. Mean Difference (IV, Fixed, 95% CI)	0.11 [‐0.39, 0.61]

4 Depression scores ‐ clinician rated post intervention Show forest plot	3	72	Std. Mean Difference (IV, Fixed, 95% CI)	0.29 [‐0.18, 0.75]

5 Depression scores ‐ clinician rated follow‐up (short‐term) Show forest plot	1		Std. Mean Difference (IV, Fixed, 95% CI)	Subtotals only

6 Non response/remission ‐ self rated post intervention Show forest plot	5	203	Risk Ratio (M‐H, Fixed, 95% CI)	1.71 [1.25, 2.34]

7 Non response/remission ‐ self rated follow‐up (short‐term) Show forest plot	3	89	Risk Ratio (M‐H, Fixed, 95% CI)	1.88 [1.05, 3.34]

8 Non response/remission ‐ clinician rated post intervention Show forest plot	3	104	Risk Ratio (M‐H, Fixed, 95% CI)	1.96 [1.20, 3.22]

9 Non response/remission ‐ clinician rated follow‐up (short‐term) Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

10 Dropouts during intervention Show forest plot	8	289	Risk Ratio (M‐H, Fixed, 95% CI)	1.59 [0.83, 3.05]

11 Dropouts during follow‐up (short‐term) Show forest plot	5	135	Risk Ratio (M‐H, Fixed, 95% CI)	1.54 [0.43, 5.51]

12 Dropouts during follow‐up (long‐term) Show forest plot	2	73	Risk Ratio (M‐H, Random, 95% CI)	2.72 [0.03, 251.39]

Comparison 2. Relaxation versus psychological treatment

Ir a la tabla de la revisión

Comparison 3. Relaxation versus lifestyle and complementary treatments

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Depression scores ‐ self rated post intervention Show forest plot	1		Std. Mean Difference (IV, Fixed, 95% CI)	Subtotals only

2 Dropouts during intervention Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

Comparison 3. Relaxation versus lifestyle and complementary treatments

Ir a la tabla de la revisión

Comparison 4. Relaxation versus medication

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Depression scores ‐ self rated post intervention Show forest plot	2	115	Std. Mean Difference (IV, Random, 95% CI)	‐0.59 [‐2.07, 0.89]

2 Depression scores ‐ self rated follow‐up (short‐term) Show forest plot	1		Std. Mean Difference (IV, Fixed, 95% CI)	Subtotals only

3 Depression scores ‐ clinician rated post intervention Show forest plot	1		Std. Mean Difference (IV, Fixed, 95% CI)	Subtotals only

4 Non response/remission ‐ self rated post intervention Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

5 Dropouts during intervention Show forest plot	2	127	Risk Ratio (M‐H, Fixed, 95% CI)	0.71 [0.39, 1.31]

Comparison 4. Relaxation versus medication

Ir a la tabla de la revisión

Comparison 5. Relaxation + medication versus medication alone

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Depression scores ‐ self rated post intervention (SMD) Show forest plot	2	40	Std. Mean Difference (IV, Fixed, 95% CI)	‐0.90 [‐1.56, ‐0.24]

2 Depression scores ‐ self rated post intervention (WMD) Show forest plot	2	40	Mean Difference (IV, Fixed, 95% CI)	‐8.03 [‐13.32, ‐2.74]

3 Depression scores ‐ self rated follow‐up (long‐term, SMD) Show forest plot	1	20	Std. Mean Difference (IV, Fixed, 95% CI)	‐0.02 [‐0.90, 0.86]

4 Depression scores ‐ self rated follow‐up (long‐term, WMD) Show forest plot	1	20	Mean Difference (IV, Fixed, 95% CI)	‐0.20 [‐9.18, 8.78]

5 Depression scores ‐ clinician rated post intervention (SMD) Show forest plot	1	20	Std. Mean Difference (IV, Fixed, 95% CI)	‐0.20 [‐1.08, 0.68]

6 Depression scores ‐ clinician rated post intervention (WMD) Show forest plot	1	20	Mean Difference (IV, Fixed, 95% CI)	‐1.20 [‐6.23, 3.83]

7 Non response/remission ‐ self rated post intervention Show forest plot	1	20	Risk Ratio (M‐H, Fixed, 95% CI)	0.05 [0.00, 0.72]

8 Non response/remission ‐ clinician rated post intervention Show forest plot	1	20	Risk Ratio (M‐H, Fixed, 95% CI)	1.13 [0.78, 1.63]

9 Dropouts during intervention Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

Comparison 5. Relaxation + medication versus medication alone

Ir a la tabla de la revisión

	Idioma de la Revisión Cochrane Escoja su idioma de preferencia para las revisiones Cochrane y otros contenidos. Las secciones sin una traducción aparecerán en inglés.

	Idioma de la web Escoja su idioma de preferencia para la web de la Biblioteca Cochrane.

Idioma de la Revisión Cochrane

Idioma de la web

Referencias

Referencias de los estudios incluidos en esta revisión

Bowers 1990 {published data only}

Byrne 1984 {published data only}

Field 1996 {published data only}

Field 2004 {published data only}

Kahn 1990 {published data only}

Krampen 1997 {published data only}

McCann 1984 {published data only}

McLean 1979 {published data only}

Murphy 1995 {published data only}

Pace 1977a {published data only}

Pace 1977b {published data only}

Reynolds 1986 {published data only}

Sonis 1987 {published data only}

Wilson 1982 {published data only}

Wood 1996 {published data only}

Referencias de los estudios excluidos de esta revisión

Broota 1990 {published data only}

Brown 1997 {published data only}

Contreras 2006 {published data only}

Corrado 1999 {published data only}

DeBerry 1982 {published data only}

DeBerry 1989 {published data only}

DeVaney 1991 {published data only}

Field 1998 {published data only}

Goodwin 2004 {published data only}

Halonen 1985 {published data only}

Holland 1991 {published data only}

Keyes 1991 {published data only}

Kirkpatrick 1977 {published data only}

Klein 1985 {published data only}

Knubben 2007 {published data only}

Krishnamurthy 2007 {published data only}

Leppamaki 2002 {published data only}

Leppamaki 2004 {published data only}

Lolak 2005 {published data only}

Maher 2002 {unpublished data only}

Parandeh 2006 {published data only}

Partonen 1998 {published data only}

Petersen 2002 {published data only}

Richards 1988 {published data only}

Roth 1987 {published data only}

Shaw 1994 {published data only}

Sloan 1981 {published data only}

Sloman 2002 {published data only}

Swenson 1986 {published data only}

Warren 1995 {published data only}

Watts 1988 {published data only}

Wetzel 1992 {published data only}

Referencias de los estudios en curso

Baillon 2003 {unpublished data only}

Krogh 2007 {published data only}

Referencias adicionales

Andrews 2000

APA 2000

Beck 1961

Beck 1996

Bernstein 1973

Cuijpers 2005

DerSimonian 1986

Eaton 1995

Endicott 1976

Fava 1990

Feighner 1972

Fergusson 2005

Gloaguen 1998

Goldberg 1972

Gompertz 1993

Guy 1976

Hamilton 1960

Hamilton 1967

Harrington 1991

Hazell 2002

Hetrick 2007

Higgins 2005

Jiang 2001

Jorm 2000