CoChat
Sign Up
Cited by 126Treatment of Major DepressionPsychotherapy Techniques and ApplicationsMental Health Treatment and Access

Initial treatment choices to achieve sustained response in major depression: a systematic review and network meta‐analysis

Open access
Furukawa, Toshi A., Shinohara, Kiyomi, Sahker, Ethan, Karyotaki, Eirini, Miguel, Clara, Ciharova, Marketa, Bockting, Claudi L.H., Breedvelt, Josefien J.F. +11 more·2021·World Psychiatry
DOI 10.1002/wps.20906PMC PMC8429344
Open this paper in CoChat — free accountOpen PDF

Abstract

Major depression is often a relapsing disorder. It is therefore important to start its treatment with therapies that maximize the chance of not only getting the patients well but also keeping them well. We examined the associations between initial treatments and sustained response by conducting a network meta‐analysis of randomized controlled trials (RCTs) in which adult patients with major depression were randomized to acute treatment with a psychotherapy (PSY), a protocolized antidepressant pharmacotherapy (PHA), their combination (COM), standard treatment in primary or secondary care (STD), or pill placebo, and were then followed up through a maintenance phase. By design, acute phase treatment could be continued into the maintenance phase, switched to another treatment or followed by discretionary treatment. We included 81 RCTs, with 13,722 participants. Sustained response was defined as responding to the acute treatment and subsequently having no depressive relapse through the maintenance phase (mean duration: 42.2±16.2 weeks, range 24‐104 weeks). We extracted the data reported at the time point closest to 12 months. COM resulted in more sustained response than PHA, both when these treatments were continued into the maintenance phase (OR=2.52, 95% CI: 1.66‐3.85) and when they were followed by discretionary treatment (OR=1.80, 95% CI: 1.21‐2.67). The same applied to COM in comparison with STD (OR=2.90, 95% CI: 1.68‐5.01 when COM was continued into the maintenance phase; OR=1.97, 95% CI: 1.51‐2.58 when COM was followed by discretionary treatment). PSY also kept the patients well more often than PHA, both when these treatments were continued into the maintenance phase (OR=1.53, 95% CI: 1.00‐2.35) and when they were followed by discretionary treatment (OR=1.66, 95% CI: 1.13‐2.44). The same applied to PSY compared with STD (OR=1.76, 95% CI: 0.97‐3.21 when PSY was continued into the maintenance phase; OR=1.83, 95% CI: 1.20‐2.78 when PSY was followed by discretionary treatment). Given the average sustained response rate of 29% on STD, the advantages of PSY or COM over PHA or STD translated into risk differences ranging from 12 to 16 percentage points. We conclude that PSY and COM have more enduring effects than PHA. Clinical guidelines on the initial treatment choice for depression may need to be updated accordingly.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1002/wps.20906

Cites

52 of 52 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Evidence indicates that psychotherapeutic interventions are a preferred treatment option over pharmacotherapy amongst persons with lived depression experience.

    “For example, evidence indicates that these interventions are a preferred treatment option over pharmacotherapy amongst persons with lived depression experience 73,260,261 .”

    From Treatment‐resistant depression: definition, prevalence, detection, management, and investigational interventions (2023) · cites this paper as [261]

    The Network meta-analyses section reports that psychotherapy produced more sustained responses than pharmacotherapy, and the Conclusions advise patients and therapists to consider psychotherapy as an initial treatment. These passages support psychotherapy as a treatment option, but they do not establish that people with lived experience of depression prefer it over pharmacotherapy; the paper reports treatment outcomes, not patient preferences. Page numbers are unavailable in our copy. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Staging models identify where an individual lies along a continuum of risk for illness progression and extension and aid in reviewing the person's needs for intervention, including early intervention.

    “They identify where an individual lies along a continuum of risk for illness progression (of the depressive illness or its underlying pathophysiology) and extension (additional complications beyond the syndrome of depression) 484,485 (Figure 8) and aid in reviewing the person's needs for intervention, including early intervention.”

    From Time for united action on depression: a Lancet–World Psychiatric Association Commission (2022) · cites this paper as [485]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. Doi SA, Furuya-Kanamori L, Xu C et al. Questionable utility of the relative risk in clinical research: a call for change to practice. J Clin Epidemiol (in press).

Cited by

Sorted by citations

Related

Authors
Furukawa, T. A., Shinohara, K., Sahker, E., Karyotaki, E., Miguel, C., Ciharova, M., Bockting, C. L. H., Breedvelt, J. J. F., Tajika, A., Imai, H., Ostinelli, E. G., Sakata, M., Toyomoto, R., Kishimoto, S., Ito, M., Furukawa, Y., Cipriani, A., Hollon, S. D., & Cuijpers, P.
Affiliations
  • Kyoto University (JP)
  • Amsterdam Public Health (NL)
  • Department of Clinical, Neuro‐ and Developmental Psychology Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam The Netherlands
  • University of Amsterdam (NL)
  • Oxford Health NHS Foundation Trust (GB)
  • University of Tokyo Hospital (JP)
  • Vanderbilt University (US)
ORCID
Venue
World Psychiatry
Publisher
Wiley
Published
2021-09-09
Volume
20
Issue
3
Pages
387-396
ISSN
  • 1723-8617 (ISSN-L)
  • 2051-5545
DOI
10.1002/wps.20906
PMC
PMC8429344
OpenAlex
W3196783567
Cited by
126
References
51
Citations by year
2026: 19 · 2025: 14 · 2024: 28 · 2023: 37 · 2022: 25 · 2021: 3
FWCI
2.95
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • World Psychiatry (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
  • Pure Amsterdam UMC (submittedVersion, other-oa)
  • VU Research Portal (submittedVersion, other-oa)
Funders
  • National Institute for Health and Care Research (RP-2017-08-ST2-006, BRC‐1215‐20005)
  • Japan Society for the Promotion of Science (17K19808, 20K10527, 20K03459)
Topics
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Keywords
major depressive disorder, sustained response, maintenance therapy, psychotherapy, antidepressant treatment, combination therapy, depression relapse, treatment switching, relapse prevention, treatment side effects, treatment intensity

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review