Treatments for partial remission of major depressive disorder: a systematic review and meta-analysis
Question Partial remission of major depressive disorder (MDD) is a debilitating and distressing clinical state related to chronicity, morbidity and relapse. Although one-third of patients remit partially, evidence for treatment efficacy is unclear. We provide an overview of treatment options and the...
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| Language: | English |
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BMJ Publishing Group
2023-11-01
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| Series: | BMJ Mental Health |
| Online Access: | https://mentalhealth.bmj.com/content/26/1/1.full |
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| author | Marlies E Brouwer Gert J Geurtsen Damiaan A J P Denys Joost Gülpen Eva A M van Dis Claudi L Bockting |
| author_facet | Marlies E Brouwer Gert J Geurtsen Damiaan A J P Denys Joost Gülpen Eva A M van Dis Claudi L Bockting |
| author_sort | Marlies E Brouwer |
| collection | DOAJ |
| description | Question Partial remission of major depressive disorder (MDD) is a debilitating and distressing clinical state related to chronicity, morbidity and relapse. Although one-third of patients remit partially, evidence for treatment efficacy is unclear. We provide an overview of treatment options and their efficacy.Study selection and analysis Embase, PsycINFO, Medline and SCOPUS were systematically searched through February 2023. Included were randomised controlled trials (RCTs) examining any treatment in patients with partially remitted MDD aged 13–65 years, reporting data on severity, remission or relapse.Findings Seven RCTs examining psychotherapy including 1024 patients were eligible. There were not enough RCTs to examine effects of pharmacotherapy. Psychotherapy was associated with lower depressive symptom severity at post-treatment (Hedges’ g=0.50; 95% CI 0.23 to 0.76), but not at follow-up up to 1 year (Hedges’ g=0.36; 95% CI −0.30 to 1.02) or longer (Hedges’ g=0.02; 95% CI −0.09 to 0.12). Psychotherapy was associated with superior remission rates at post-treatment (OR 2.57; 95% CI 1.71 to 3.87) and follow-up 6 months or longer (OR 1.75; 95% CI 1.21 to 2.53), although not with improved relapse rates at post-treatment (OR 0.17; 95% CI 0.01 to 4.83) or follow-up 6 months or longer (OR 0.46; 95% CI 0.21 to 1.03). Overall methodological quality was poor.Conclusions Psychotherapy targeting partial remission may be effective in lowering depressive symptom severity and patients may potentially achieve full remission twice as likely. Yet, long-term and prophylactic effects are lacking. Given the risk of chronicity, more high-quality RCTs are needed.PROSPERO registration number CRD42020188451. |
| format | Article |
| id | doaj-art-d8eae7e7f678478da7ac15fe9062f429 |
| institution | Kabale University |
| issn | 2755-9734 |
| language | English |
| publishDate | 2023-11-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Mental Health |
| spelling | doaj-art-d8eae7e7f678478da7ac15fe9062f4292025-02-09T05:55:09ZengBMJ Publishing GroupBMJ Mental Health2755-97342023-11-0126110.1136/bmjment-2023-300827Treatments for partial remission of major depressive disorder: a systematic review and meta-analysisMarlies E Brouwer0Gert J Geurtsen1Damiaan A J P Denys2Joost Gülpen3Eva A M van Dis4Claudi L Bockting52 Mental Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands3 Department of Medical Psychology, Amsterdam UMC Location AMC, Amsterdam, The NetherlandsPsychiatry, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands1 Department of Psychiatry, Amsterdam UMC Location AMC, Amsterdam, The Netherlands1 Department of Psychiatry, Amsterdam UMC Location AMC, Amsterdam, The Netherlands1 Department of Psychiatry, Amsterdam UMC Location AMC, Amsterdam, The NetherlandsQuestion Partial remission of major depressive disorder (MDD) is a debilitating and distressing clinical state related to chronicity, morbidity and relapse. Although one-third of patients remit partially, evidence for treatment efficacy is unclear. We provide an overview of treatment options and their efficacy.Study selection and analysis Embase, PsycINFO, Medline and SCOPUS were systematically searched through February 2023. Included were randomised controlled trials (RCTs) examining any treatment in patients with partially remitted MDD aged 13–65 years, reporting data on severity, remission or relapse.Findings Seven RCTs examining psychotherapy including 1024 patients were eligible. There were not enough RCTs to examine effects of pharmacotherapy. Psychotherapy was associated with lower depressive symptom severity at post-treatment (Hedges’ g=0.50; 95% CI 0.23 to 0.76), but not at follow-up up to 1 year (Hedges’ g=0.36; 95% CI −0.30 to 1.02) or longer (Hedges’ g=0.02; 95% CI −0.09 to 0.12). Psychotherapy was associated with superior remission rates at post-treatment (OR 2.57; 95% CI 1.71 to 3.87) and follow-up 6 months or longer (OR 1.75; 95% CI 1.21 to 2.53), although not with improved relapse rates at post-treatment (OR 0.17; 95% CI 0.01 to 4.83) or follow-up 6 months or longer (OR 0.46; 95% CI 0.21 to 1.03). Overall methodological quality was poor.Conclusions Psychotherapy targeting partial remission may be effective in lowering depressive symptom severity and patients may potentially achieve full remission twice as likely. Yet, long-term and prophylactic effects are lacking. Given the risk of chronicity, more high-quality RCTs are needed.PROSPERO registration number CRD42020188451.https://mentalhealth.bmj.com/content/26/1/1.full |
| spellingShingle | Marlies E Brouwer Gert J Geurtsen Damiaan A J P Denys Joost Gülpen Eva A M van Dis Claudi L Bockting Treatments for partial remission of major depressive disorder: a systematic review and meta-analysis BMJ Mental Health |
| title | Treatments for partial remission of major depressive disorder: a systematic review and meta-analysis |
| title_full | Treatments for partial remission of major depressive disorder: a systematic review and meta-analysis |
| title_fullStr | Treatments for partial remission of major depressive disorder: a systematic review and meta-analysis |
| title_full_unstemmed | Treatments for partial remission of major depressive disorder: a systematic review and meta-analysis |
| title_short | Treatments for partial remission of major depressive disorder: a systematic review and meta-analysis |
| title_sort | treatments for partial remission of major depressive disorder a systematic review and meta analysis |
| url | https://mentalhealth.bmj.com/content/26/1/1.full |
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