What are the effects of psychotherapy for adults with depression?
The issue
A high prevalence of psychiatric morbidity has been reported internationally. Estimates indicate that 20–30% of the general public in several countries – Australia, Canada, the Netherlands, New Zealand, the United States of America and the Caribbean and Scandinavian countries – satisfy the criteria for a psychiatric diagnosis. Where a diagnosis is provided, depression is the most common. The symptoms vary, but often include loss of energy and feelings of hopelessness and worthlessness. Depression can appear as a single episode or follow a pattern of recurring episodes. It also varies in severity. Depression has extensive consequences for the individual’s self-perceived functioning and reduced workplace productivity and increased disability pensions often consequently affect society.
The most common treatments for depression involve antidepressant medications and various forms of conversational therapy, used separately or in combination. Psychotherapy is a group of different types of conversational therapy, and its effects are debated.
Findings
The results show that patients significantly improved after psychotherapy, so that they were no longer considered clinically depressed or experienced fewer symptoms. The effects were sustained over several months. Findings suggest that psychotherapy is effective in reducing patients’ depression symptomatology compared to treatment as usual (such as guidance by a physician). Improvements from psychotherapy are similar to those observed for antidepressant medications. When comparing different variants of psychotherapy – such as psychodynamic psychotherapy, cognitive behavioural therapy, behavioural therapy and support therapy – no specific variant appears to be superior.
According to the best available evidence, psychotherapy appears to improve depression symptomatology. The evidence base was heterogeneous, however, so the results must be viewed as tentative.
Policy considerations
According to this systematic review, psychotherapy appears to be beneficial in the treatment of people with depression. Nevertheless, the evidence base is not solid. To establish the optimal treatment for adults, further high-quality research is needed to gain more knowledge that can be the basis for sound decision-making.
Type of evidence
This systematic review included and summarized the effects of psychotherapy for adults with depression from nine studies. Most were considered of high quality. The studies included patients from Finland, Ireland, Norway, Spain and the United Kingdom (Great Britain).
The views expressed in this summary are based on a publication of a HEN Network member agency and do not necessarily represent the decisions or stated policy of WHO/Europe.
