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Cochrane Database of Systematic Reviews

Skuteczność psychoterapii w porównaniu z lekami przeciwdepresyjnymi (stosowanymi w monterapii lub w ramach leczenia skojarzonego) u dzieci lub młodzieży z rozpoznaniem depresji

Información

DOI:
https://doi.org/10.1002/14651858.CD008324.pub3Copiar DOI
Base de datos:
  1. Cochrane Database of Systematic Reviews
Versión publicada:
  1. 30 noviembre 2014see what's new
Tipo:
  1. Intervention
Etapa:
  1. Review
Grupo Editorial Cochrane:
  1. Grupo Cochrane de Trastornos mentales comunes

Copyright:
  1. Copyright © 2014 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Contraer

Autores

  • Georgina R Cox

    Correspondencia a: Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia

    [email protected]

  • Patch Callahan

    Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia

  • Rachel Churchill

    Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, Bristol, UK

  • Vivien Hunot

    Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, Bristol, UK

  • Sally N Merry

    Department of Psychological Medicine, University of Auckland, Auckland, New Zealand

  • Alexandra G Parker

    Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia

  • Sarah E Hetrick

    Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia

    headspace Centre of Excellence, Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia

Contributions of authors

Sarah Hetrick (SH) conceived the review and co‐ordinated the development of the original protocol. She assisted with selection of articles for inclusion, data extraction and guided the data analysis. She had oversight of the write‐up of the review.

Georgina Cox (GC) assisted in selecting articles from the updated search, extracted descriptive and numerical data for all included studies, inputted data into meta‐analyses and was heavily involved in writing the Methods, Description of studies, Results and Discussion sections of the review.

Patrick Callahan (PC) assisted in the development of the original protocol for this review, executed the search of electronic databases, screened and selected articles for inclusion, extracted descriptive and numerical data for all included studies, and was involved in inputting data into meta‐analyses.

Rachel Churchill (RC) assisted in the development of the original protocol and provided input to the data analysis and write‐up of the review.

Vivien Hunot (VH) assisted in the development of the original protocol and provided input to the data analysis and write‐up of the review.

Alex Parker (AP) assisted in the development of the original protocol and had input into the write‐up of the review.

Sally Merry (SM) assisted in the development of the original protocol and had input, particularly from a clinical point of view, into the write‐up of the review.

Sources of support

Internal sources

  • Headspace, Australia.

    Australian Government funding for the National Youth Mental Health Foundation

External sources

  • No sources of support supplied

Declarations of interest

There are no known conflicts of interest in this working group.

Acknowledgements

Thanks to Judy Stoelwinder for assisting in the development of search strategies for the original review and to the CCDAN editorial team for ongoing support and advice. We are also grateful to trial authors Paula Riggs and Glenn Melvin who were able to provide us with additional data for this review.

Thanks to Sarah Dawson who undertook the searching and screening of retrivals from the search for the 2014 update, as well as to Karla Soares Weiser who performed the data extration and under took the risk of bias assessment for the newly included trial identified for inclusion in the updated review.

Version history

Published

Title

Stage

Authors

Version

2014 Nov 30

Psychological therapies versus antidepressant medication, alone and in combination for depression in children and adolescents

Review

Georgina R Cox, Patch Callahan, Rachel Churchill, Vivien Hunot, Sally N Merry, Alexandra G Parker, Sarah E Hetrick

https://doi.org/10.1002/14651858.CD008324.pub3

2012 Nov 14

Psychological therapies versus antidepressant medication, alone and in combination for depression in children and adolescents

Review

Georgina R Cox, Patch Callahan, Rachel Churchill, Vivien Hunot, Sally N Merry, Alexandra G Parker, Sarah E Hetrick

https://doi.org/10.1002/14651858.CD008324.pub2

2010 Jan 20

Psychological therapies versus antidepressant medication, alone and in combination for depression in children and adolescents

Protocol

Patch Callahan, Sarah E Hetrick, Rachel Churchill, Vivien Hunot, Sally N Merry, Alexandra G Parker

https://doi.org/10.1002/14651858.CD008324

Differences between protocol and review

One additional objective was added to the review following the publication of the protocol. Given the concern that antidepressant medication may increase suicide related behaviours in children and adolescents, we felt it was important to assess the degree of suicide related behaviours related to antidepressant medication. Therefore a final objective was:

6. To determine whether there is an increased risk of suicide related outcomes in children and adolescents treated with antidepressant medication alone, compared with psychological therapy alone, or a combination of treatments.

Keywords

MeSH

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

PRISMA flow diagram: CCDANCTR update search June 2014
Figuras y tablas -
Figure 1

PRISMA flow diagram: CCDANCTR update search June 2014

Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
Figuras y tablas -
Figure 2

Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.

Comparison 1 Psychological therapy versus antidepressant medication, Outcome 1 Remission by clinical interview (post‐intervention) ITT.
Figuras y tablas -
Analysis 1.1

Comparison 1 Psychological therapy versus antidepressant medication, Outcome 1 Remission by clinical interview (post‐intervention) ITT.

Comparison 1 Psychological therapy versus antidepressant medication, Outcome 2 Remission by clinical interview (post‐intervention) OC.
Figuras y tablas -
Analysis 1.2

Comparison 1 Psychological therapy versus antidepressant medication, Outcome 2 Remission by clinical interview (post‐intervention) OC.

Comparison 1 Psychological therapy versus antidepressant medication, Outcome 3 Remission by clinical interview (six to nine months follow‐up) ITT.
Figuras y tablas -
Analysis 1.3

Comparison 1 Psychological therapy versus antidepressant medication, Outcome 3 Remission by clinical interview (six to nine months follow‐up) ITT.

Comparison 1 Psychological therapy versus antidepressant medication, Outcome 4 Remission by clinical interview (six to nine months follow‐up) OC.
Figuras y tablas -
Analysis 1.4

Comparison 1 Psychological therapy versus antidepressant medication, Outcome 4 Remission by clinical interview (six to nine months follow‐up) OC.

Comparison 1 Psychological therapy versus antidepressant medication, Outcome 5 Dropouts (post‐intervention).
Figuras y tablas -
Analysis 1.5

Comparison 1 Psychological therapy versus antidepressant medication, Outcome 5 Dropouts (post‐intervention).

Comparison 1 Psychological therapy versus antidepressant medication, Outcome 6 Dropouts (six to nine months follow‐up).
Figuras y tablas -
Analysis 1.6

Comparison 1 Psychological therapy versus antidepressant medication, Outcome 6 Dropouts (six to nine months follow‐up).

Comparison 1 Psychological therapy versus antidepressant medication, Outcome 7 Suicidal ideation (post‐intervention).
Figuras y tablas -
Analysis 1.7

Comparison 1 Psychological therapy versus antidepressant medication, Outcome 7 Suicidal ideation (post‐intervention).

Comparison 1 Psychological therapy versus antidepressant medication, Outcome 8 Suicidal ideation (six to nine months follow‐up).
Figuras y tablas -
Analysis 1.8

Comparison 1 Psychological therapy versus antidepressant medication, Outcome 8 Suicidal ideation (six to nine months follow‐up).

Comparison 1 Psychological therapy versus antidepressant medication, Outcome 9 Suicidal ideation (post‐intervention).
Figuras y tablas -
Analysis 1.9

Comparison 1 Psychological therapy versus antidepressant medication, Outcome 9 Suicidal ideation (post‐intervention).

Comparison 1 Psychological therapy versus antidepressant medication, Outcome 10 Suicidal ideation (six to nine months follow‐up).
Figuras y tablas -
Analysis 1.10

Comparison 1 Psychological therapy versus antidepressant medication, Outcome 10 Suicidal ideation (six to nine months follow‐up).

Comparison 1 Psychological therapy versus antidepressant medication, Outcome 11 Suicidal ideation (12 months follow‐up).
Figuras y tablas -
Analysis 1.11

Comparison 1 Psychological therapy versus antidepressant medication, Outcome 11 Suicidal ideation (12 months follow‐up).

Comparison 1 Psychological therapy versus antidepressant medication, Outcome 12 Remission by cut‐off (post‐intervention).
Figuras y tablas -
Analysis 1.12

Comparison 1 Psychological therapy versus antidepressant medication, Outcome 12 Remission by cut‐off (post‐intervention).

Comparison 1 Psychological therapy versus antidepressant medication, Outcome 13 Remission by cut‐off (six to nine months follow‐up).
Figuras y tablas -
Analysis 1.13

Comparison 1 Psychological therapy versus antidepressant medication, Outcome 13 Remission by cut‐off (six to nine months follow‐up).

Comparison 1 Psychological therapy versus antidepressant medication, Outcome 14 Remission by cut‐off (12 months follow‐up).
Figuras y tablas -
Analysis 1.14

Comparison 1 Psychological therapy versus antidepressant medication, Outcome 14 Remission by cut‐off (12 months follow‐up).

Comparison 1 Psychological therapy versus antidepressant medication, Outcome 15 Depression symptoms clinician rated (CDRS‐R) (post‐intervention).
Figuras y tablas -
Analysis 1.15

Comparison 1 Psychological therapy versus antidepressant medication, Outcome 15 Depression symptoms clinician rated (CDRS‐R) (post‐intervention).

Comparison 1 Psychological therapy versus antidepressant medication, Outcome 16 Depression symptoms clinician rated (CDRS‐R) (six to nine months follow‐up).
Figuras y tablas -
Analysis 1.16

Comparison 1 Psychological therapy versus antidepressant medication, Outcome 16 Depression symptoms clinician rated (CDRS‐R) (six to nine months follow‐up).

Comparison 1 Psychological therapy versus antidepressant medication, Outcome 17 Depression symptoms clinician rated (CDRS‐R) (12 months follow‐up).
Figuras y tablas -
Analysis 1.17

Comparison 1 Psychological therapy versus antidepressant medication, Outcome 17 Depression symptoms clinician rated (CDRS‐R) (12 months follow‐up).

Comparison 1 Psychological therapy versus antidepressant medication, Outcome 18 Depression symptoms self rated (post‐intervention).
Figuras y tablas -
Analysis 1.18

Comparison 1 Psychological therapy versus antidepressant medication, Outcome 18 Depression symptoms self rated (post‐intervention).

Comparison 1 Psychological therapy versus antidepressant medication, Outcome 19 Depression symptoms self rated (six to nine months follow‐up).
Figuras y tablas -
Analysis 1.19

Comparison 1 Psychological therapy versus antidepressant medication, Outcome 19 Depression symptoms self rated (six to nine months follow‐up).

Comparison 1 Psychological therapy versus antidepressant medication, Outcome 20 Depression symptoms self rated (12 months follow‐up).
Figuras y tablas -
Analysis 1.20

Comparison 1 Psychological therapy versus antidepressant medication, Outcome 20 Depression symptoms self rated (12 months follow‐up).

Comparison 1 Psychological therapy versus antidepressant medication, Outcome 21 Functioning (post‐intervention).
Figuras y tablas -
Analysis 1.21

Comparison 1 Psychological therapy versus antidepressant medication, Outcome 21 Functioning (post‐intervention).

Comparison 1 Psychological therapy versus antidepressant medication, Outcome 22 Functioning (six to nine months follow‐up).
Figuras y tablas -
Analysis 1.22

Comparison 1 Psychological therapy versus antidepressant medication, Outcome 22 Functioning (six to nine months follow‐up).

Comparison 2 Combination therapy versus antidepressant medication, Outcome 1 Remission by clinical interview (post‐intervention) ITT.
Figuras y tablas -
Analysis 2.1

Comparison 2 Combination therapy versus antidepressant medication, Outcome 1 Remission by clinical interview (post‐intervention) ITT.

Comparison 2 Combination therapy versus antidepressant medication, Outcome 2 Remission by clinical interview (post‐intervention) OC.
Figuras y tablas -
Analysis 2.2

Comparison 2 Combination therapy versus antidepressant medication, Outcome 2 Remission by clinical interview (post‐intervention) OC.

Comparison 2 Combination therapy versus antidepressant medication, Outcome 3 Remission by clinical interview (six to nine months follow‐up) ITT.
Figuras y tablas -
Analysis 2.3

Comparison 2 Combination therapy versus antidepressant medication, Outcome 3 Remission by clinical interview (six to nine months follow‐up) ITT.

Comparison 2 Combination therapy versus antidepressant medication, Outcome 4 Remission by clinical interview (six to nine months follow‐up) OC.
Figuras y tablas -
Analysis 2.4

Comparison 2 Combination therapy versus antidepressant medication, Outcome 4 Remission by clinical interview (six to nine months follow‐up) OC.

Comparison 2 Combination therapy versus antidepressant medication, Outcome 5 Remission by clinical interview (12 months follow‐up).
Figuras y tablas -
Analysis 2.5

Comparison 2 Combination therapy versus antidepressant medication, Outcome 5 Remission by clinical interview (12 months follow‐up).

Comparison 2 Combination therapy versus antidepressant medication, Outcome 6 Dropouts (post‐intervention).
Figuras y tablas -
Analysis 2.6

Comparison 2 Combination therapy versus antidepressant medication, Outcome 6 Dropouts (post‐intervention).

Comparison 2 Combination therapy versus antidepressant medication, Outcome 7 Dropouts (six to nine months follow‐up).
Figuras y tablas -
Analysis 2.7

Comparison 2 Combination therapy versus antidepressant medication, Outcome 7 Dropouts (six to nine months follow‐up).

Comparison 2 Combination therapy versus antidepressant medication, Outcome 8 Dropouts (12 months follow‐up).
Figuras y tablas -
Analysis 2.8

Comparison 2 Combination therapy versus antidepressant medication, Outcome 8 Dropouts (12 months follow‐up).

Comparison 2 Combination therapy versus antidepressant medication, Outcome 9 Suicidal ideation (post‐intervention).
Figuras y tablas -
Analysis 2.9

Comparison 2 Combination therapy versus antidepressant medication, Outcome 9 Suicidal ideation (post‐intervention).

Comparison 2 Combination therapy versus antidepressant medication, Outcome 10 Suicidal ideation (six to nine months follow‐up).
Figuras y tablas -
Analysis 2.10

Comparison 2 Combination therapy versus antidepressant medication, Outcome 10 Suicidal ideation (six to nine months follow‐up).

Comparison 2 Combination therapy versus antidepressant medication, Outcome 11 Suicidal ideation (12 months follow‐up).
Figuras y tablas -
Analysis 2.11

Comparison 2 Combination therapy versus antidepressant medication, Outcome 11 Suicidal ideation (12 months follow‐up).

Comparison 2 Combination therapy versus antidepressant medication, Outcome 12 Suicidal ideation (post‐intervention).
Figuras y tablas -
Analysis 2.12

Comparison 2 Combination therapy versus antidepressant medication, Outcome 12 Suicidal ideation (post‐intervention).

Comparison 2 Combination therapy versus antidepressant medication, Outcome 13 Suicidal ideation (six to nine months follow‐up).
Figuras y tablas -
Analysis 2.13

Comparison 2 Combination therapy versus antidepressant medication, Outcome 13 Suicidal ideation (six to nine months follow‐up).

Comparison 2 Combination therapy versus antidepressant medication, Outcome 14 Suicidal ideation (12 months follow‐up).
Figuras y tablas -
Analysis 2.14

Comparison 2 Combination therapy versus antidepressant medication, Outcome 14 Suicidal ideation (12 months follow‐up).

Comparison 2 Combination therapy versus antidepressant medication, Outcome 15 Remission by cut‐off (post‐intervention).
Figuras y tablas -
Analysis 2.15

Comparison 2 Combination therapy versus antidepressant medication, Outcome 15 Remission by cut‐off (post‐intervention).

Comparison 2 Combination therapy versus antidepressant medication, Outcome 16 Remission by cut‐off (six to nine months follow‐up).
Figuras y tablas -
Analysis 2.16

Comparison 2 Combination therapy versus antidepressant medication, Outcome 16 Remission by cut‐off (six to nine months follow‐up).

Comparison 2 Combination therapy versus antidepressant medication, Outcome 17 Remission by cut‐off (12 months follow‐up).
Figuras y tablas -
Analysis 2.17

Comparison 2 Combination therapy versus antidepressant medication, Outcome 17 Remission by cut‐off (12 months follow‐up).

Comparison 2 Combination therapy versus antidepressant medication, Outcome 18 Depression symptoms clinician rated (CDRS‐R) (post‐intervention).
Figuras y tablas -
Analysis 2.18

Comparison 2 Combination therapy versus antidepressant medication, Outcome 18 Depression symptoms clinician rated (CDRS‐R) (post‐intervention).

Comparison 2 Combination therapy versus antidepressant medication, Outcome 19 Depression symptoms clinician rated (CDRS‐R) (six to nine months follow‐up).
Figuras y tablas -
Analysis 2.19

Comparison 2 Combination therapy versus antidepressant medication, Outcome 19 Depression symptoms clinician rated (CDRS‐R) (six to nine months follow‐up).

Comparison 2 Combination therapy versus antidepressant medication, Outcome 20 Depression symptoms clinician rated (CDRS‐R) (12 months follow‐up).
Figuras y tablas -
Analysis 2.20

Comparison 2 Combination therapy versus antidepressant medication, Outcome 20 Depression symptoms clinician rated (CDRS‐R) (12 months follow‐up).

Comparison 2 Combination therapy versus antidepressant medication, Outcome 21 Depression symptoms self rated (post‐intervention).
Figuras y tablas -
Analysis 2.21

Comparison 2 Combination therapy versus antidepressant medication, Outcome 21 Depression symptoms self rated (post‐intervention).

Comparison 2 Combination therapy versus antidepressant medication, Outcome 22 Depression symptoms self rated (six to nine months follow‐up).
Figuras y tablas -
Analysis 2.22

Comparison 2 Combination therapy versus antidepressant medication, Outcome 22 Depression symptoms self rated (six to nine months follow‐up).

Comparison 2 Combination therapy versus antidepressant medication, Outcome 23 Depression symptoms self rated (12 months follow‐up).
Figuras y tablas -
Analysis 2.23

Comparison 2 Combination therapy versus antidepressant medication, Outcome 23 Depression symptoms self rated (12 months follow‐up).

Comparison 2 Combination therapy versus antidepressant medication, Outcome 24 Functioning (post‐intervention).
Figuras y tablas -
Analysis 2.24

Comparison 2 Combination therapy versus antidepressant medication, Outcome 24 Functioning (post‐intervention).

Comparison 2 Combination therapy versus antidepressant medication, Outcome 25 Functioning (six to nine months follow‐up).
Figuras y tablas -
Analysis 2.25

Comparison 2 Combination therapy versus antidepressant medication, Outcome 25 Functioning (six to nine months follow‐up).

Comparison 2 Combination therapy versus antidepressant medication, Outcome 26 Functioning (12 months follow‐up).
Figuras y tablas -
Analysis 2.26

Comparison 2 Combination therapy versus antidepressant medication, Outcome 26 Functioning (12 months follow‐up).

Comparison 3 Combination therapy versus psychological therapy, Outcome 1 Remission by clinical interview (post‐intervention) ITT.
Figuras y tablas -
Analysis 3.1

Comparison 3 Combination therapy versus psychological therapy, Outcome 1 Remission by clinical interview (post‐intervention) ITT.

Comparison 3 Combination therapy versus psychological therapy, Outcome 2 Remission by clinical interview (post‐intervention) OC.
Figuras y tablas -
Analysis 3.2

Comparison 3 Combination therapy versus psychological therapy, Outcome 2 Remission by clinical interview (post‐intervention) OC.

Comparison 3 Combination therapy versus psychological therapy, Outcome 3 Remission by clinical interview (six to nine months follow‐up) ITT.
Figuras y tablas -
Analysis 3.3

Comparison 3 Combination therapy versus psychological therapy, Outcome 3 Remission by clinical interview (six to nine months follow‐up) ITT.

Comparison 3 Combination therapy versus psychological therapy, Outcome 4 Remission by clinical interview (six to nine months follow‐up) OC.
Figuras y tablas -
Analysis 3.4

Comparison 3 Combination therapy versus psychological therapy, Outcome 4 Remission by clinical interview (six to nine months follow‐up) OC.

Comparison 3 Combination therapy versus psychological therapy, Outcome 5 Dropouts (post‐intervention).
Figuras y tablas -
Analysis 3.5

Comparison 3 Combination therapy versus psychological therapy, Outcome 5 Dropouts (post‐intervention).

Comparison 3 Combination therapy versus psychological therapy, Outcome 6 Dropouts (six to nine months follow‐up).
Figuras y tablas -
Analysis 3.6

Comparison 3 Combination therapy versus psychological therapy, Outcome 6 Dropouts (six to nine months follow‐up).

Comparison 3 Combination therapy versus psychological therapy, Outcome 7 Suicidal ideation (post‐intervention).
Figuras y tablas -
Analysis 3.7

Comparison 3 Combination therapy versus psychological therapy, Outcome 7 Suicidal ideation (post‐intervention).

Comparison 3 Combination therapy versus psychological therapy, Outcome 8 Suicidal ideation (six to nine months follow‐up).
Figuras y tablas -
Analysis 3.8

Comparison 3 Combination therapy versus psychological therapy, Outcome 8 Suicidal ideation (six to nine months follow‐up).

Comparison 3 Combination therapy versus psychological therapy, Outcome 9 Suicidal ideation (post‐intervention).
Figuras y tablas -
Analysis 3.9

Comparison 3 Combination therapy versus psychological therapy, Outcome 9 Suicidal ideation (post‐intervention).

Comparison 3 Combination therapy versus psychological therapy, Outcome 10 Suicidal ideation (six to nine months follow‐up).
Figuras y tablas -
Analysis 3.10

Comparison 3 Combination therapy versus psychological therapy, Outcome 10 Suicidal ideation (six to nine months follow‐up).

Comparison 3 Combination therapy versus psychological therapy, Outcome 11 Suicidal ideation (12 months follow‐up).
Figuras y tablas -
Analysis 3.11

Comparison 3 Combination therapy versus psychological therapy, Outcome 11 Suicidal ideation (12 months follow‐up).

Comparison 3 Combination therapy versus psychological therapy, Outcome 12 Remission by cut‐off (post‐intervention).
Figuras y tablas -
Analysis 3.12

Comparison 3 Combination therapy versus psychological therapy, Outcome 12 Remission by cut‐off (post‐intervention).

Comparison 3 Combination therapy versus psychological therapy, Outcome 13 Remission by cut‐off (six to nine months follow‐up).
Figuras y tablas -
Analysis 3.13

Comparison 3 Combination therapy versus psychological therapy, Outcome 13 Remission by cut‐off (six to nine months follow‐up).

Comparison 3 Combination therapy versus psychological therapy, Outcome 14 Remission by cut‐off (12 months follow‐up).
Figuras y tablas -
Analysis 3.14

Comparison 3 Combination therapy versus psychological therapy, Outcome 14 Remission by cut‐off (12 months follow‐up).

Comparison 3 Combination therapy versus psychological therapy, Outcome 15 Depression symptoms clinician rated (CDRS‐R) (post‐intervention).
Figuras y tablas -
Analysis 3.15

Comparison 3 Combination therapy versus psychological therapy, Outcome 15 Depression symptoms clinician rated (CDRS‐R) (post‐intervention).

Comparison 3 Combination therapy versus psychological therapy, Outcome 16 Depression symptoms clinician rated (CDRS‐R) (six to nine months follow‐up).
Figuras y tablas -
Analysis 3.16

Comparison 3 Combination therapy versus psychological therapy, Outcome 16 Depression symptoms clinician rated (CDRS‐R) (six to nine months follow‐up).

Comparison 3 Combination therapy versus psychological therapy, Outcome 17 Depression symptoms clinician rated (CDRS‐R) (12 months follow‐up).
Figuras y tablas -
Analysis 3.17

Comparison 3 Combination therapy versus psychological therapy, Outcome 17 Depression symptoms clinician rated (CDRS‐R) (12 months follow‐up).

Comparison 3 Combination therapy versus psychological therapy, Outcome 18 Depression symptoms self rated (post‐intervention).
Figuras y tablas -
Analysis 3.18

Comparison 3 Combination therapy versus psychological therapy, Outcome 18 Depression symptoms self rated (post‐intervention).

Comparison 3 Combination therapy versus psychological therapy, Outcome 19 Depression symptoms self rated (six to nine months follow‐up).
Figuras y tablas -
Analysis 3.19

Comparison 3 Combination therapy versus psychological therapy, Outcome 19 Depression symptoms self rated (six to nine months follow‐up).

Comparison 3 Combination therapy versus psychological therapy, Outcome 20 Depression symptoms self rated (12 months follow‐up).
Figuras y tablas -
Analysis 3.20

Comparison 3 Combination therapy versus psychological therapy, Outcome 20 Depression symptoms self rated (12 months follow‐up).

Comparison 3 Combination therapy versus psychological therapy, Outcome 21 Functioning (post‐intervention).
Figuras y tablas -
Analysis 3.21

Comparison 3 Combination therapy versus psychological therapy, Outcome 21 Functioning (post‐intervention).

Comparison 3 Combination therapy versus psychological therapy, Outcome 22 Functioning (six to nine months follow‐up).
Figuras y tablas -
Analysis 3.22

Comparison 3 Combination therapy versus psychological therapy, Outcome 22 Functioning (six to nine months follow‐up).

Comparison 4 Combination therapy versus psychological therapy plus placebo, Outcome 1 Dropouts (post‐intervention).
Figuras y tablas -
Analysis 4.1

Comparison 4 Combination therapy versus psychological therapy plus placebo, Outcome 1 Dropouts (post‐intervention).

Comparison 4 Combination therapy versus psychological therapy plus placebo, Outcome 2 Suicidal ideation (post‐intervention).
Figuras y tablas -
Analysis 4.2

Comparison 4 Combination therapy versus psychological therapy plus placebo, Outcome 2 Suicidal ideation (post‐intervention).

Comparison 4 Combination therapy versus psychological therapy plus placebo, Outcome 3 Remission by cut‐off (post‐intervention).
Figuras y tablas -
Analysis 4.3

Comparison 4 Combination therapy versus psychological therapy plus placebo, Outcome 3 Remission by cut‐off (post‐intervention).

Comparison 4 Combination therapy versus psychological therapy plus placebo, Outcome 4 Remission by cut‐off (12 months follow‐up).
Figuras y tablas -
Analysis 4.4

Comparison 4 Combination therapy versus psychological therapy plus placebo, Outcome 4 Remission by cut‐off (12 months follow‐up).

Comparison 4 Combination therapy versus psychological therapy plus placebo, Outcome 5 Depression symptoms clinician rated (CDRS‐R) (post‐intervention).
Figuras y tablas -
Analysis 4.5

Comparison 4 Combination therapy versus psychological therapy plus placebo, Outcome 5 Depression symptoms clinician rated (CDRS‐R) (post‐intervention).

Comparison 4 Combination therapy versus psychological therapy plus placebo, Outcome 6 Depression symptoms self rated (post‐intervention).
Figuras y tablas -
Analysis 4.6

Comparison 4 Combination therapy versus psychological therapy plus placebo, Outcome 6 Depression symptoms self rated (post‐intervention).

Comparison 1. Psychological therapy versus antidepressant medication

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Remission by clinical interview (post‐intervention) ITT Show forest plot

2

268

Odds Ratio (M‐H, Random, 95% CI)

0.62 [0.28, 1.35]

2 Remission by clinical interview (post‐intervention) OC Show forest plot

2

220

Odds Ratio (M‐H, Random, 95% CI)

0.52 [0.27, 0.98]

3 Remission by clinical interview (six to nine months follow‐up) ITT Show forest plot

1

Odds Ratio (M‐H, Random, 95% CI)

Totals not selected

4 Remission by clinical interview (six to nine months follow‐up) OC Show forest plot

1

Odds Ratio (M‐H, Random, 95% CI)

Totals not selected

5 Dropouts (post‐intervention) Show forest plot

2

271

Odds Ratio (M‐H, Random, 95% CI)

0.61 [0.11, 3.28]

6 Dropouts (six to nine months follow‐up) Show forest plot

2

223

Odds Ratio (M‐H, Random, 95% CI)

1.17 [0.63, 2.19]

7 Suicidal ideation (post‐intervention) Show forest plot

1

Odds Ratio (M‐H, Random, 95% CI)

Totals not selected

8 Suicidal ideation (six to nine months follow‐up) Show forest plot

1

Odds Ratio (M‐H, Random, 95% CI)

Totals not selected

9 Suicidal ideation (post‐intervention) Show forest plot

2

268

Mean Difference (IV, Random, 95% CI)

‐3.12 [‐5.91, ‐0.33]

10 Suicidal ideation (six to nine months follow‐up) Show forest plot

2

268

Mean Difference (IV, Random, 95% CI)

‐2.89 [‐5.49, ‐0.28]

11 Suicidal ideation (12 months follow‐up) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

12 Remission by cut‐off (post‐intervention) Show forest plot

1

Odds Ratio (M‐H, Random, 95% CI)

Totals not selected

13 Remission by cut‐off (six to nine months follow‐up) Show forest plot

1

Odds Ratio (M‐H, Random, 95% CI)

Totals not selected

14 Remission by cut‐off (12 months follow‐up) Show forest plot

1

Odds Ratio (M‐H, Random, 95% CI)

Totals not selected

15 Depression symptoms clinician rated (CDRS‐R) (post‐intervention) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

16 Depression symptoms clinician rated (CDRS‐R) (six to nine months follow‐up) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

17 Depression symptoms clinician rated (CDRS‐R) (12 months follow‐up) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

18 Depression symptoms self rated (post‐intervention) Show forest plot

2

255

Std. Mean Difference (IV, Random, 95% CI)

0.16 [‐0.69, 1.01]

19 Depression symptoms self rated (six to nine months follow‐up) Show forest plot

2

268

Std. Mean Difference (IV, Random, 95% CI)

‐0.04 [‐0.51, 0.42]

20 Depression symptoms self rated (12 months follow‐up) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

21 Functioning (post‐intervention) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

22 Functioning (six to nine months follow‐up) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

Figuras y tablas -
Comparison 1. Psychological therapy versus antidepressant medication
Comparison 2. Combination therapy versus antidepressant medication

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Remission by clinical interview (post‐intervention) ITT Show forest plot

3

419

Odds Ratio (M‐H, Random, 95% CI)

1.50 [0.99, 2.27]

2 Remission by clinical interview (post‐intervention) OC Show forest plot

3

378

Odds Ratio (M‐H, Random, 95% CI)

1.56 [0.98, 2.47]

3 Remission by clinical interview (six to nine months follow‐up) ITT Show forest plot

2

203

Odds Ratio (M‐H, Random, 95% CI)

1.93 [0.93, 4.00]

4 Remission by clinical interview (six to nine months follow‐up) OC Show forest plot

2

193

Odds Ratio (M‐H, Random, 95% CI)

1.94 [0.88, 4.27]

5 Remission by clinical interview (12 months follow‐up) Show forest plot

1

Odds Ratio (M‐H, Random, 95% CI)

Totals not selected

6 Dropouts (post‐intervention) Show forest plot

5

699

Odds Ratio (M‐H, Random, 95% CI)

0.84 [0.51, 1.39]

7 Dropouts (six to nine months follow‐up) Show forest plot

3

420

Odds Ratio (M‐H, Random, 95% CI)

0.94 [0.54, 1.64]

8 Dropouts (12 months follow‐up) Show forest plot

1

Odds Ratio (M‐H, Random, 95% CI)

Totals not selected

9 Suicidal ideation (post‐intervention) Show forest plot

2

388

Odds Ratio (M‐H, Random, 95% CI)

0.75 [0.26, 2.16]

10 Suicidal ideation (six to nine months follow‐up) Show forest plot

2

344

Odds Ratio (M‐H, Random, 95% CI)

0.53 [0.06, 4.58]

11 Suicidal ideation (12 months follow‐up) Show forest plot

1

Odds Ratio (M‐H, Random, 95% CI)

Totals not selected

12 Suicidal ideation (post‐intervention) Show forest plot

2

267

Mean Difference (IV, Random, 95% CI)

‐2.57 [‐5.53, 0.40]

13 Suicidal ideation (six to nine months follow‐up) Show forest plot

2

267

Mean Difference (IV, Random, 95% CI)

‐1.89 [‐4.50, 0.72]

14 Suicidal ideation (12 months follow‐up) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

15 Remission by cut‐off (post‐intervention) Show forest plot

1

Odds Ratio (M‐H, Random, 95% CI)

Totals not selected

16 Remission by cut‐off (six to nine months follow‐up) Show forest plot

1

Odds Ratio (M‐H, Random, 95% CI)

Totals not selected

17 Remission by cut‐off (12 months follow‐up) Show forest plot

2

319

Odds Ratio (M‐H, Random, 95% CI)

1.45 [0.60, 3.52]

18 Depression symptoms clinician rated (CDRS‐R) (post‐intervention) Show forest plot

2

415

Mean Difference (IV, Random, 95% CI)

‐0.27 [‐4.95, 4.41]

19 Depression symptoms clinician rated (CDRS‐R) (six to nine months follow‐up) Show forest plot

2

408

Mean Difference (IV, Random, 95% CI)

‐0.27 [‐2.26, 1.72]

20 Depression symptoms clinician rated (CDRS‐R) (12 months follow‐up) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

21 Depression symptoms self rated (post‐intervention) Show forest plot

5

683

Std. Mean Difference (IV, Random, 95% CI)

‐0.14 [‐0.36, 0.09]

22 Depression symptoms self rated (six to nine months follow‐up) Show forest plot

4

610

Std. Mean Difference (IV, Random, 95% CI)

‐0.06 [‐0.28, 0.17]

23 Depression symptoms self rated (12 months follow‐up) Show forest plot

2

368

Std. Mean Difference (IV, Random, 95% CI)

‐0.26 [‐0.46, ‐0.05]

24 Functioning (post‐intervention) Show forest plot

3

396

Std. Mean Difference (IV, Random, 95% CI)

0.09 [‐0.11, 0.28]

25 Functioning (six to nine months follow‐up) Show forest plot

3

385

Std. Mean Difference (IV, Random, 95% CI)

0.08 [‐0.12, 0.28]

26 Functioning (12 months follow‐up) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

Figuras y tablas -
Comparison 2. Combination therapy versus antidepressant medication
Comparison 3. Combination therapy versus psychological therapy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Remission by clinical interview (post‐intervention) ITT Show forest plot

2

265

Odds Ratio (M‐H, Random, 95% CI)

1.61 [0.38, 6.90]

2 Remission by clinical interview (post‐intervention) OC Show forest plot

2

222

Odds Ratio (M‐H, Random, 95% CI)

1.82 [0.38, 8.68]

3 Remission by clinical interview (six to nine months follow‐up) ITT Show forest plot

1

Odds Ratio (M‐H, Random, 95% CI)

Totals not selected

4 Remission by clinical interview (six to nine months follow‐up) OC Show forest plot

1

Odds Ratio (M‐H, Random, 95% CI)

Totals not selected

5 Dropouts (post‐intervention) Show forest plot

2

265

Odds Ratio (M‐H, Random, 95% CI)

1.23 [0.12, 12.71]

6 Dropouts (six to nine months follow‐up) Show forest plot

2

231

Odds Ratio (M‐H, Random, 95% CI)

0.75 [0.40, 1.42]

7 Suicidal ideation (post‐intervention) Show forest plot

1

Odds Ratio (M‐H, Random, 95% CI)

Totals not selected

8 Suicidal ideation (six to nine months follow‐up) Show forest plot

1

Odds Ratio (M‐H, Random, 95% CI)

Totals not selected

9 Suicidal ideation (post‐intervention) Show forest plot

2

265

Mean Difference (IV, Random, 95% CI)

0.60 [‐2.25, 3.45]

10 Suicidal ideation (six to nine months follow‐up) Show forest plot

2

265

Mean Difference (IV, Random, 95% CI)

1.78 [‐2.29, 5.85]

11 Suicidal ideation (12 months follow‐up) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

12 Remission by cut‐off (post‐intervention) Show forest plot

1

Odds Ratio (M‐H, Random, 95% CI)

Totals not selected

13 Remission by cut‐off (six to nine months follow‐up) Show forest plot

1

Odds Ratio (M‐H, Random, 95% CI)

Totals not selected

14 Remission by cut‐off (12 months follow‐up) Show forest plot

1

Odds Ratio (M‐H, Random, 95% CI)

Totals not selected

15 Depression symptoms clinician rated (CDRS‐R) (post‐intervention) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

16 Depression symptoms clinician rated (CDRS‐R) (six to nine months follow‐up) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

17 Depression symptoms clinician rated (CDRS‐R) (12 months follow‐up) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

18 Depression symptoms self rated (post‐intervention) Show forest plot

2

265

Std. Mean Difference (IV, Random, 95% CI)

‐0.28 [‐1.41, 0.84]

19 Depression symptoms self rated (six to nine months follow‐up) Show forest plot

2

265

Std. Mean Difference (IV, Random, 95% CI)

‐0.16 [‐0.63, 0.31]

20 Depression symptoms self rated (12 months follow‐up) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

21 Functioning (post‐intervention) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

22 Functioning (six to nine months follow‐up) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

Figuras y tablas -
Comparison 3. Combination therapy versus psychological therapy
Comparison 4. Combination therapy versus psychological therapy plus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Dropouts (post‐intervention) Show forest plot

4

249

Odds Ratio (M‐H, Random, 95% CI)

0.98 [0.42, 2.28]

2 Suicidal ideation (post‐intervention) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

3 Remission by cut‐off (post‐intervention) Show forest plot

2

173

Odds Ratio (M‐H, Random, 95% CI)

2.15 [1.15, 4.02]

4 Remission by cut‐off (12 months follow‐up) Show forest plot

1

Odds Ratio (M‐H, Random, 95% CI)

Totals not selected

5 Depression symptoms clinician rated (CDRS‐R) (post‐intervention) Show forest plot

3

239

Std. Mean Difference (IV, Random, 95% CI)

‐0.52 [‐0.78, ‐0.26]

6 Depression symptoms self rated (post‐intervention) Show forest plot

3

123

Std. Mean Difference (IV, Random, 95% CI)

‐0.34 [‐0.70, 0.02]

Figuras y tablas -
Comparison 4. Combination therapy versus psychological therapy plus placebo