Different talking treatments all work well for depression, with a review of studies finding that no one type of therapy works much better than others.
BMJ Group News
What do we know already?
Talking treatments (called psychotherapies) are often offered to people diagnosed with depression. They are also sometimes used along with antidepressants.
There are many types of talking treatments, and they can be provided one to one, in groups, or over the internet. With so many options, experts have wondered whether some types, or some formats, work better than others. However, not enough studies have directly compared different types of talking treatments to provide a clear answer.
In the new study, researchers took a different approach to explore this. They pooled the results of studies that either directly compared people having different types of talking treatments, or compared people having talking treatments with ‘control groups’ of people not having any of these treatments. How well the treatment groups compared with the control groups provided further insight about how the treatments might stack up against each other.
The reviewers looked at nearly 200 studies involving more than 15,000 adults with depression. The studies focused on the following seven types of talking treatments:
- Behavioural activation raises awareness of pleasant activities and seeks to increase positive interactions between a person and their environment.
- Cognitive behaviour therapy teaches people how to recognise and control unhelpful or negative thoughts and replace them with good thoughts.
- Interpersonal therapy explores how relationships affect depression.
- Problem-solving therapy aims to help people define and address problems to improve their depression.
- Psychodynamic therapy focuses on unresolved conflicts and relationships, and how they affect people.
- Social skills therapy teaches people skills to help build and maintain healthy relationships.
- Supportive counselling is a more general type of therapy that encourages people to talk about their experiences and emotions.
What does the new study say?
Overall, people having any of the seven talking treatments were more likely to improve than people not having these treatments. The researchers estimated that the average person having treatment fared better than about half the people not having them.
When the researchers compared the different talking treatments, they found only small differences, or no differences at all, among them in how well they worked. This suggests that none of the treatments was much better or worse than the others. They also found that the talking treatments worked equally well for different groups of people with depression, including younger and older adults, and women with depression after giving birth ( postnatal depression). There was also no notable difference among the various formats for treatment, including one-to-one, group, and internet-based therapy.
How reliable is the research?
This was a good-quality review that included only randomised controlled trials, which are the best type of study for finding out the effects of treatments and comparing them.
However, most of the studies were small, with fewer than 50 people having any one type of talking treatment. This may make these studies less reliable. When the researchers looked only at larger studies, they found clear improvements only for people having cognitive behaviour therapy, interpersonal therapy, and problem-solving therapy. More research will need to explore this.
What does this mean for me?
If you have depression, these findings show that all seven types of talking treatments can help you feel better, with no one type being much better than the others. This suggests that you and your doctor can base your treatment decision on which therapy is most appealing to you and best suited to your needs. However, it’s worth noting that not all of these types of talking treatments may be available in your area.
