TY - JOUR
T1 - Can non-pharmacological interventions prevent relapse in adults who have recovered from depression? A systematic review and meta-analysis of randomised controlled trials
AU - Clarke, Katherine
AU - Mayo-Wilson, Evan
AU - Kenny, Jocelyne
AU - Pilling, Stephen
N1 - Funding Information:
This study was supported by a grant from the British Psychological Society to SP (grant number 509517 ). The funding source had no involvement in the study design, collection, analysis, or interpretation of data, writing the manuscript, and the decision to submit the manuscript for publication.
Funding Information:
SP also receives funding from NICE for the production of clinical guidelines. KC, EM-W and JK have no financial or other conflicts of interest to declare.
Publisher Copyright:
© 2015 Elsevier Ltd.
PY - 2015/7/1
Y1 - 2015/7/1
N2 - Objective: To identify studies of non-pharmacological interventions provided following recovery from depression, and to evaluate their efficacy in preventing further episodes. Method: We identified relevant randomised controlled trials from searching MEDLINE, Embase, PsycINFO, CENTRAL, and ProQuest, searching reference and citation lists, and contacting study authors. We conducted a meta-analysis of relapse outcomes. Results: There were 29 eligible trials. 27 two-way comparisons including 2742 participants were included in the primary analysis. At 12. months cognitive-behavioural therapy (CBT), mindfulness-based cognitive therapy (MBCT), and interpersonal psychotherapy (IPT) were associated with a 22% reduction in relapse compared with controls (95% CI 15% to 29%). The effect was maintained at 24. months for CBT, but not for IPT despite ongoing sessions. There were no 24-month MBCT data. A key area of heterogeneity differentiating these groups was prior acute treatment. Other psychological therapies and service-level programmes varied in efficacy. Conclusion and implications: Psychological interventions may prolong the recovery a person has achieved through use of medication or acute psychological therapy. Although there was evidence that MBCT is effective, it was largely tested following medication, so its efficacy following psychological interventions is less clear. IPT was only tested following acute IPT. Further exploration of sequencing of interventions is needed. Systematic review registration number: PROSPERO 2011:CRD42011001646.
AB - Objective: To identify studies of non-pharmacological interventions provided following recovery from depression, and to evaluate their efficacy in preventing further episodes. Method: We identified relevant randomised controlled trials from searching MEDLINE, Embase, PsycINFO, CENTRAL, and ProQuest, searching reference and citation lists, and contacting study authors. We conducted a meta-analysis of relapse outcomes. Results: There were 29 eligible trials. 27 two-way comparisons including 2742 participants were included in the primary analysis. At 12. months cognitive-behavioural therapy (CBT), mindfulness-based cognitive therapy (MBCT), and interpersonal psychotherapy (IPT) were associated with a 22% reduction in relapse compared with controls (95% CI 15% to 29%). The effect was maintained at 24. months for CBT, but not for IPT despite ongoing sessions. There were no 24-month MBCT data. A key area of heterogeneity differentiating these groups was prior acute treatment. Other psychological therapies and service-level programmes varied in efficacy. Conclusion and implications: Psychological interventions may prolong the recovery a person has achieved through use of medication or acute psychological therapy. Although there was evidence that MBCT is effective, it was largely tested following medication, so its efficacy following psychological interventions is less clear. IPT was only tested following acute IPT. Further exploration of sequencing of interventions is needed. Systematic review registration number: PROSPERO 2011:CRD42011001646.
KW - Depression
KW - Long-term
KW - Prevent
KW - Psychological therapy
KW - Relapse
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U2 - 10.1016/j.cpr.2015.04.002
DO - 10.1016/j.cpr.2015.04.002
M3 - Review article
C2 - 25939032
AN - SCOPUS:84928750507
SN - 0272-7358
VL - 39
SP - 58
EP - 70
JO - Clinical Psychology Review
JF - Clinical Psychology Review
ER -