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Cited by 562Treatment of Major DepressionElectroconvulsive Therapy StudiesTranscranial Magnetic Stimulation Studies

Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder

Open access
Parikh, Sagar V., Quilty, Lena C., Ravitz, Paula, Rosenbluth, Michael, Pavlova, Barbara, Grigoriadis, Sophie, Velyvis, Vytas, Kennedy, Sidney H. +6 more·2016·The Canadian Journal of Psychiatry
DOI 10.1177/0706743716659418PMC PMC4994791
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Abstract

Background: The Canadian Network for Mood and Anxiety Treatments (CANMAT) has revised its 2009 guidelines for the management of major depressive disorder (MDD) in adults by updating the evidence and recommendations. The target audiences for these 2016 guidelines are psychiatrists and other mental health professionals. Methods: Using the question-answer format, we conducted a systematic literature search focusing on systematic reviews and meta-analyses. Evidence was graded using CANMAT-defined criteria for level of evidence. Recommendations for lines of treatment were based on the quality of evidence and clinical expert consensus. "Psychological Treatments" is the second of six sections of the 2016 guidelines. Results: Evidence-informed responses were developed for 25 questions under 5 broad categories: 1) patient characteristics relevant to using psychological interventions; 2) therapist and health system characteristics associated with optimizing outcomes; 3) descriptions of major psychotherapies and their efficacy; 4) additional psychological interventions, such as peer interventions and computer- and technology-delivered interventions; and 5) combining and/or sequencing psychological and pharmacological interventions. Conclusions: First-line psychological treatment recommendations for acute MDD include cognitive-behavioural therapy (CBT), interpersonal therapy (IPT), and behavioural activation (BA). Second-line recommendations include computer-based and telephone-delivered psychotherapy. Where feasible, combining psychological treatment (CBT or IPT) with antidepressant treatment is recommended because combined treatment is superior to either treatment alone. First-line psychological treatments for maintenance include CBT and mindfulness-based cognitive therapy (MBCT). Patient preference, in combination with evidence-based treatments and clinician/system capacity, will yield the optimal treatment strategies for improving individual outcomes in MDD. © The Author(s) 2016.

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Crossref · 10.1177/0706743716659418

Cites

271 of 271 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

64 of 178 cited sources checked · 23 supported · 1 flagged · accuracy not yet measured

  • Premisecitation

    There is Level 2 Evidence for treatment of depression with co-occurring cardiovascular disease for CBT, interpersonal therapy (IPT), and problem-solving therapy (PST).

    “there is Level 2 Evidence for treatment of depression with co-occurring cardiovascular disease for CBT, interpersonal therapy (IPT), and problem-solving therapy (PST).25,[27][28][29]”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [25] 25. Ramasubbu R, Taylor VH, Samaan Z, et al. The Canadian Network for Mood and Anxiety Treatments (CANMAT) task force recommendations for the management of patients with mood disorders and select comorbid medical conditions. Ann Clin Psychiatry. 2012;24:91-109. source
    • cites [27] 27. Dickens C, Cherrington A, Adeyemi I, et al. Characteristics of psychological interventions that improve depression in people with coronary heart disease: a systematic review and meta- regression. Psychosom Med. 2013;75:211-221. source
    • cites [28] 28. Mavrides N, Nemeroff C. Treatment of depression in cardio- vascular disease. Depress Anxiety. 2013;30:328-341. source

      The Psychotherapeutic Interventions section reports improved depression scores for a problem-solving-therapy intervention that could also include medication, and the Discussion reports a positive CBT trial. But the Discussion says psychotherapy trial results were mixed and IPT showed no additional benefit over usual care. The paper does not assign these therapies a “Level 2 Evidence” rating. Page numbers are unavailable in our copy. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
  • Premisecitation

    The magnitude of benefit for psychological treatment appears to increase with increasing severity.

    “the magnitude of benefit for psychological treatment appears to increase with increasing severity, 17”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [17] 17. Bower P, Kontopantelis E, Sutton A, et al. Influence of initial severity of depression on effectiveness of low intensity inter- ventions: meta-analysis of individual patient data. BMJ. 2013;346:f540. source

      The section on whether baseline severity moderates effectiveness reports that more severely depressed patients had larger treatment effects. But the analysis concerns low-intensity interventions for depression, not psychological treatment generally; the increase was small and might not be clinically significant. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
  • Premisecitation

    Psychological treatments are beneficial even for subthreshold depressive symptoms.

    “there is evidence that psychological treatments are beneficial even for subthreshold depressive symptoms.18”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [18] 18. Cuijpers P, Koole SL, van Dijke A, et al. Psychotherapy for subclinical depression: meta-analysis. Br J Psychiatry. 2014; 205:268-274. source
  • Premisecitation

    In persistent depressive disorder (PDD), medication treatment or combination of medication with psychological treatment provides more benefit than psychological treatment alone.

    “In persistent depressive disorder (PDD), medication treatment or combination of medication with psychological treatment provides more benefit than psychological treatment alone.12,13”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [12] 12. Cuijpers P, Huibers M, Ebert DD, et al. How much psy- chotherapy is needed to treat depression? A metaregression analysis. J Affect Disord. 2013;149:1-13. source
    • cites [13] 13. Kriston L, von Wolff A, Westphal A, et al. Efficacy and acceptability of acute treatments for persistent depressive dis- order: a network meta-analysis. Depress Anxiety. 2014;31: 621-630. source

      The Efficacy and Acceptability of Psychotherapeutic and Combined Treatments section (page not provided) reports that medication was more effective than interpersonal psychotherapy (IPT) alone, and that IPT plus medication was more effective than medication alone at borderline significance. But it found no significant efficacy difference between medication and CBASP, with or without medication. The claim overgeneralizes these treatment-specific findings to psychological treatment alone across PDD. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
  • Premisecitation

    Psychological treatments in general and CBT in particular appear to be equally effective for different subtypes of depression, including atypical, melancholic, and anxious depression.

    “Psychological treatments in general and cognitive-behavioural therapy (CBT) in particular appear to be equally effective for different subtypes of depression, including atypical depression, melancholic depression, and anxious depression.9,10”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [9] 9. Simon GE, Perlis RH. Personalized medicine for depression: can we match patients with treatments? Am J Psychiatry. 2010;167:1445-1455. source

      The Selection of a Specific Psychotherapy section discusses whether clinical characteristics predict different responses to cognitive therapy and other psychotherapies, but does not compare effectiveness across atypical, melancholic, and anxious depression. The section on specific antidepressants discusses atypical symptoms and anxiety only in relation to medication response. Searches for these subtypes alongside psychotherapy and CBT found no passage supporting the cited claim; page numbers were not available in our copy. (LLM, conf=0.74)

      Experimental — accuracy not yet measured
    • cites [10] 10. Driessen E, Hollon SD. Cognitive behavioral therapy for mood disorders: efficacy, moderators and mediators. Psy- chiatr Clin North Am. 2010;33:537-555. source

      In “CBT for severe depression” (page unavailable), the paper reports that cognitive therapy was as efficacious as phenelzine for atypical depression. In “Illness characteristics” (page unavailable), it says there is little evidence that melancholic depression responds less well to CBT than to medication. It does not establish equal effectiveness across the named subtypes, address anxious depression, or make that subtype-wide claim for psychological treatments generally. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
  • Classified as probably not a substantial claim. 7
  • May combine two claims. 39

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Level 2 Evidence supports peer interventions as a second-line adjunctive treatment for MDD.

    “peer interventions are recommended as a second-line adjunctive treatment for MDD (Level 2 Evidence).”
    Quote in the paperSubstantial claim3 of 3 sources checked
    • cites [134] source

      The Discussion and Conclusion report that peer support improves depressive symptoms compared with usual care and may be an effective component of depression care. They do not recommend it specifically as a second-line adjunctive treatment or assign it a “Level 2 Evidence” grade. The Results section also says trials studying peer support only as an add-on to depression care management were excluded. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [135] 135. Fuhr DC, Salisbury TT, De Silva MJ, et al. Effectiveness of peer-delivered interventions for severe mental illness and depression on clinical and psychosocial outcomes: a systematic review and meta-analysis. Soc Psychiatry Psy- chiatr Epidemiol. 2014;49:1691-1702. source

      The Results section, ‘Effect of peer-delivered interventions on depression’ (page unavailable), reports no effect on clinical outcomes or loneliness compared with usual care. The paper does not assign a Level 2 evidence grade or recommend peer interventions as a second-line adjunctive treatment for MDD; its reported depression findings run contrary to that recommendation. (LLM, conf=0.86)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
    • cites [136] 136. Valenstein M, Pfeiffer PN, Brandfon S, et al. Augmenting ongoing depression care with a mutual peer support interven- tion versus self-help materials alone: a randomized trial. Psy- chiatr Serv. 2016;67:236-239. source

      The Methods describe testing peer support alongside ongoing depression treatment, so the paper supports its use as an adjunct in the trial. But the Results and Conclusions report no benefit over enhanced usual care; they do not recommend peer interventions as second-line treatment or assign a Level 2 evidence rating. The authors say other peer-support models might be more effective. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • Rests on an assumption: Peer support can be beneficial either alone or as a complement to clinical care.

  • May combine two claims.

    Premisecitation

    Psychological treatments benefit men and women to the same extent and are equally suitable for individuals of all ages, levels of education, and cultural and ethnic backgrounds.

    “Psychological treatments benefit men and women to the same extent; psychological treatments are equally suitable for individuals of all ages, levels of education, and cultural and ethnic backgrounds.9”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [9] 9. Simon GE, Perlis RH. Personalized medicine for depression: can we match patients with treatments? Am J Psychiatry. 2010;167:1445-1455. source

      The Introduction says specific psychotherapies have success comparable to antidepressant medication as first-line treatment for moderate depression, supporting a general claim of benefit. It does not establish equal benefit for men and women or equal suitability across ages, education levels, and cultural or ethnic backgrounds; the sections on treatment selection instead discuss other patient characteristics. (LLM, conf=0.84)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    In the presence of HIV, psychological treatments improve adherence to medical interventions as well as depression.

    “importantly, improved adherence to medical interventions as well as improvement in depression.32”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [32] 32. Sin NL, DiMatteo MR. Depression treatment enhances adher- ence to antiretroviral therapy: a meta-analysis. Ann Behav Med. 2014;47:259-269. source

  • May combine two claims.

    Premisecitation

    Therapist experience, adherence, and ability to be responsive to individual patient differences are associated with better outcomes.

    “Therapist experience, adherence, and ability to be responsive to individual patient differences are associated with better outcomes.54,55”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [54] 54. Fournier JC, DeRubeis RJ, Amsterdam J, et al. Gains in employ- ment status following antidepressant medication or cognitive therapy for depression. Br J Psychiatry. 2015;206:332-338. source

      The Methods (Acute Treatment; page unavailable) say therapist qualifications and adherence were characterized elsewhere, but do not link either to outcomes. The Discussion (page unavailable) raises differences in therapists’ techniques only as an untested explanation for site differences. Searches for therapist experience, adherence, and responsiveness to individual patients found no passage establishing the claimed association. (LLM, conf=0.77)

      Experimental — accuracy not yet measured
    • cites [55] 55. Johnsen TJ, Friborg O. The effects of cognitive behavioral therapy as an anti-depressive treatment is falling: a meta- analysis. Psychol Bull. 2015;141:747-768. source

  • May combine two claims.

    Premisecitation

    Even less-trained therapists can have efficacy in treating depression and may be the only source of treatment.

    “although even less-trained therapists can have efficacy in treating depression and indeed may be the only source of treatment.56”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [56] 56. van Ginneken N, Tharyan P, Lewin S, et al. Non-specialist health worker interventions for the care of mental, neurologi- cal and substance-abuse disorders in low-and middle-income countries. Cochrane Database Syst Rev. 2013;11:CD009149. source

  • May combine two claims.

    Premisecitation

    Some meta-analytic comparisons between specific models of psychological treatment have shown no significant differences in efficacy, while others have shown modest differences.

    “Some meta-analytic comparisons between specific models of psychological treatment have shown no significant differences in efficacy, 57 with others showing modest differences.58”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [57] 57. Cuijpers P, Berking M, Andersson G, et al. A meta-analysis of cognitive-behavioural therapy for adult depression, alone and in comparison with other treatments. Can J Psychiatry. 2013; 58:376-385. source
    • cites [58] 58. Linde K, Ru ¨cker G, Sigterman K, et al. Comparative effec- tiveness of psychological treatments for depressive disorders in primary care: network meta-analysis. BMC Fam Pract. 2015;16:103. source

  • May combine two claims.

    Premisecitation

    The most recent large trial of CBASP (N=491 in 3 conditions) produced results inconsistent with previous results and do not support the efficacy of CBASP.

    “results of the most recent large trial (N ¼ 491 in 3 conditions) are inconsistent with previous results and do not support the efficacy of CBASP.75”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [75] 75. Kocsis JH, Gelenberg AJ, Rothbaum BO, et al. Cognitive behavioral analysis system of psychotherapy and brief sup- portive psychotherapy for augmentation of antidepressant nonresponse in chronic depression: the REVAMP Trial. Arch Gen Psychiatry. 2009;66:1178-1188. source

      The Results table lists 96 patients receiving medication alone, 195 receiving medication plus BSP, and 200 receiving medication plus CBASP—491 across three conditions. The Results discussion says adding CBASP did not significantly improve outcomes and that the findings contradicted predictions from previous studies. But the trial tested CBASP only as an addition to medication for chronically depressed patients who had not fully responded to initial medication; it does not establish a general lack of CBASP efficacy. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Group therapy is less effective than individual therapy at the end of treatment and has a higher dropout rate, although no differences were found at follow-up.

    “However, group therapy was less effective than individual therapy at the end of treatment and had a higher dropout rate, although no differences were found at follow-up.77”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [77] 77. Huntley AL, Araya R, Salisbury C. Group psychological therapies for depression in the community: systematic review and meta-analysis. Br J Psychiatry. 2012;200:184-190. source

      The “Group CBT v. individual CBT therapy” section reports better outcomes for individual CBT immediately after treatment and no evidence of a difference at short- or longer-term follow-up. It does not report a higher dropout rate for group therapy; the “Individual CBT v. group CBT” section instead notes that four of seven studies gave no dropout details. The comparison also concerns CBT specifically, rather than group and individual therapy generally. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Using a different definition of bona-fide therapy, supportive therapy was less effective than other types of therapy, with no differences between CBT, IPT, and psychodynamic psychotherapy (PDT).

    “using a different definition of bona-fide therapy, supportive therapy was less effective than other types of therapy, with no differences between CBT, IPT, and psychodynamic psychotherapy (PDT).60”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [60] 60. Braun SR, Gregor B, Tran US. Comparing bona fide psy- chotherapies of depression in adults with two meta- analytical approaches. PLoS One. 2013;8:e68135. source

      The Results (Type I Meta-Analyses; page unavailable) report no efficacy difference among CBT, IPT, and psychodynamic therapy, and lower efficacy for some supportive-therapy subtypes on specific post-treatment measures. The Abstract (Results; page unavailable) says there were no significant differences at follow-up, while the Discussion describes the supportive-therapy finding as small and tentative. The claim omits those limits and states the lower efficacy categorically. (LLM, conf=0.85)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Several meta-analyses demonstrate efficacy of MBCT, and a large, high-quality RCT (N=424) demonstrated equal efficacy of MBCT to medication as maintenance treatment for recurrent MDD.

    “With several meta-analyses demonstrating efficacy 67,68 and a large, high-quality RCT (N ¼ 424) 69 demonstrating equal efficacy of MBCT to medication as maintenance treatment for recurrent MDD”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites [67] 67. Galante J, Iribarren SJ, Pearce PF. Effects of mindfulness- based cognitive therapy on mental disorders: a systematic review and meta-analysis of randomised controlled trials. J Res Nurs. 2013;18:133-155. source
    • cites [68] 68. Piet J, Hougaard E. The effect of mindfulness-based cognitive therapy for prevention of relapse in recurrent major depres- sive disorder: a systematic review and meta-analysis. Clin Psychol Rev. 2011;31:1032-1040. source
    • cites [69] 69. Kuyken W, Hayes R, Barrett B, et al. Effectiveness and cost- effectiveness of mindfulness-based cognitive therapy com- pared with maintenance antidepressant treatment in the pre- vention of depressive relapse or recurrence (PREVENT): a randomised controlled trial. Lancet. 2015;386:63-73. source

      The Results report that the trial recruited 424 patients, and the Discussion describes MBCT with support to taper antidepressants (MBCT-TS) as not superior to maintenance antidepressants over two years. The paper supports MBCT-TS as an alternative, but the trial did not establish equal efficacy; its finding of no superiority does not prove equivalence. The meta-analyses in the citing sentence have separate citations and are not judged here. (LLM, conf=0.85)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    An RCT of 469 primary care patients with depression with poor response to medication found CBT improved response and remission, with sustained effects at 3-year follow-up.

    “An RCT of 469 primary care patients with depression with poor response to medication found CBT improved response and remission, 63 with sustained effects at 3-year follow-up.89”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [63] 63. Wiles N, Thomas L, Abel A, et al. Cognitive behavioural therapy as an adjunct to pharmacotherapy for primary care based patients with treatment resistant depression: results of the CoBalT randomised controlled trial. Lancet. 2013;381: 375-384. source
    • cites [89] 89. Wiles NJ, Thomas L, Turner N, et al. Long-term effectiveness and cost-effectiveness of cognitive behavioural therapy as an adjunct to pharmacotherapy for treatment-resistant depres- sion in primary care: follow-up of the CoBalT randomised controlled trial. Lancet Psychiatry. 2016;3:137-144. source

  • May combine two claims.

    Interpretationcitation

    There is only weak evidence, and only after prolonged treatment, for efficacy of long-term PDT for acute treatment of MDD.

    “However, there is only weak evidence, and only after prolonged treatment, for efficacy of long-term PDT for acute treatment of MDD.74,109”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [74] 74. Fonagy P, Rost F, Carlyle J, et al. Pragmatic randomized con- trolled trial of long-term psychoanalytic psychotherapy for treatment-resistant depression: the Tavistock Adult Depression Study (TADS). World Psychiatry. 2015;14:312-321. source

      The Abstract says evidence for longer-term psychoanalytic treatment was at an early stage and suggests benefits particularly over longer follow-up. The Outcomes section reports no significant difference in partial remission at the end of treatment, with differences emerging during follow-up. However, this trial studied treatment-resistant depression, not acute treatment of MDD generally, so it does not support that broader setting. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [109] 109. Leichsenring F, Ablon S, Barber JP, et al. Developing a pro- totype for short-term psychodynamic (supportive-expressive) therapy: an empirical study with the psychotherapy process Q-set. Psychother Res. 2015;26:500-510. source

  • May combine two claims.

    Findingcitation

    Since the first CBASP trial published in 2000, 5 CBASP studies have been published that provide only mixed results supporting CBASP.

    “Since the first CBASP trial published in 2000, 114 5 CBASP studies have been published that provide only mixed results supporting CBASP.75,[115][116][117][118]”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [75] 75. Kocsis JH, Gelenberg AJ, Rothbaum BO, et al. Cognitive behavioral analysis system of psychotherapy and brief sup- portive psychotherapy for augmentation of antidepressant nonresponse in chronic depression: the REVAMP Trial. Arch Gen Psychiatry. 2009;66:1178-1188. source

      The Results (Comment; page unavailable) say this trial found no added benefit from CBASP and that its findings contradicted previous studies, supporting the characterization of mixed results. The paper does not establish that exactly five CBASP studies had been published since the first trial in 2000. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [115] 115. Schatzberg AF, Rush AJ, Arnow BA, et al. Chronic depres- sion: medication (nefazodone) or psychotherapy (CBASP) is effective when the other is not. Arch Gen Psychiatry. 2005; 62:513-520. source
    • cites [116] 116. Schramm E, Zobel I, Dykierek P, et al. Cognitive behavioral analysis system of psychotherapy versus interpersonal psy- chotherapy for early-onset chronic depression: a randomized pilot study. J Affect Disord. 2011;129:109-116. source

  • May combine two claims.

    Premisecitation

    Clinical trials have supported MBCT's therapeutic value as an adjunct to treatment as usual and its comparability to maintenance antidepressant medication.

    “Clinical trials have supported its therapeutic value as an adjunct to treatment as usual 94,95 and its comparability to maintenance antidepressant medication 69,96 in this context.”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites [94] 94. Bondolfi G, Jermann F, der Linden MV, et al. Depression relapse prophylaxis with mindfulness-based cognitive ther- apy: replication and extension in the Swiss health care system. J Affect Disord. 2010;122:224-231. source
    • cites [95] 95. Godfrin KA, van Heeringen C. The effects of mindfulness- based cognitive therapy on recurrence of depressive episodes, mental health and quality of life: a randomized controlled study. Behav Res Ther. 2010;48:738-746. source
    • cites [69] 69. Kuyken W, Hayes R, Barrett B, et al. Effectiveness and cost- effectiveness of mindfulness-based cognitive therapy com- pared with maintenance antidepressant treatment in the pre- vention of depressive relapse or recurrence (PREVENT): a randomised controlled trial. Lancet. 2015;386:63-73. source

  • May combine two claims.

    Premisecitation

    An initial meta-analysis of peer support for depression was positive, but subsequent results are mixed.

    “An initial meta-analysis of peer support for depression was positive, but subsequent results are mixed.[134][135][136]”
    Quote in the paperNot a substantial claim3 of 3 sources checked
    • cites [134] source
    • cites [135] 135. Fuhr DC, Salisbury TT, De Silva MJ, et al. Effectiveness of peer-delivered interventions for severe mental illness and depression on clinical and psychosocial outcomes: a systematic review and meta-analysis. Soc Psychiatry Psy- chiatr Epidemiol. 2014;49:1691-1702. source

      The Results section, ‘Effect of peer-delivered interventions on depression’ (page not provided), reports no significant effect on clinical outcomes or loneliness, supporting the claim that later findings were not uniformly positive. The Introduction mentions earlier reviews but does not say an initial meta-analysis of peer support for depression was positive. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites [136] 136. Valenstein M, Pfeiffer PN, Brandfon S, et al. Augmenting ongoing depression care with a mutual peer support interven- tion versus self-help materials alone: a randomized trial. Psy- chiatr Serv. 2016;67:236-239. source

      The paper’s discussion of prior evidence (page unavailable) says findings for peer-support interventions have been mixed, and its Results report no significant difference between its intervention and comparison groups. Its References list a meta-analysis of peer support for depression, but the available text does not say that the meta-analysis was positive. (LLM, conf=0.84)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Both telephone-delivered and in-person PST were effective for treating MDD in low-income homebound older adults.

    “Both telephone-delivered and in-person PST were effective for treating MDD in low-income homebound older adults.139”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [139] 139. Choi NG, Marti CN, Bruce ML, et al. Six-month postinter- vention depression and disability outcomes of in-home tele- health problem-solving therapy for depressed, low-income homebound older adults. Depress Anxiety. 2014;31:653-661. source

      The Discussion (page not available) reports that both tele-PST and in-person PST were effective for depression in low-income homebound older adults. But the Intervention section specifies that tele-PST used Skype video calls, not telephone delivery; telephone calls were a separate support-only comparison group. The Participants and Settings section defines eligibility by a depression-rating score, rather than an MDD diagnosis. (LLM, conf=0.92)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    In 16 studies of various diagnoses, there was improvement in depressive symptoms and anxiety with ACT, although less than with CBT.

    “In 16 studies of various diagnoses, there was improvement in depressive symptoms and anxiety with ACT, although less than with CBT.”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [120] 120. Powers MB, Zum Vorde Sive Vording MB, Emmelkamp PMG. Acceptance and commitment therapy: a meta- analytic review. Psychother Psychosom. 2009;78:73-80. source
    • cites [121] 121. Ruiz FJ. Acceptance and commitment therapy versus tradi- tional cognitive behavioral therapy: a systematic review and meta-analysis of current empirical evidence. Int J Psychol Psychol Ther. 2012;12:333-357.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [122] 122. A-Tjak JGL, Davis ML, Morina N, et al. A meta-analysis of the efficacy of acceptance and commitment therapy for clini- cally relevant mental and physical health problems. Psy- chother Psychosom. 2015;84:30-36. source

      The Effect Size as a Function of Target Problem section reports better anxiety/depression outcomes with ACT than with control conditions, supporting the improvement claim. But this paper analyzed 39 trials, not 16; its Discussion identifies 16 as the number in a separate meta-analysis by Ruiz. The Discussion also reports no significant difference between ACT and established treatments such as CBT, with effect sizes appearing slightly larger for ACT—not less improvement than with CBT. Page numbers were not available in our copy. (LLM, conf=0.90)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    The broader application of videoconferencing technologies to psychiatry has been extensively reviewed and found to be acceptable and generally equivalent to face-to-face care for many psychiatric conditions.

    “The broader application of such technologies to psychiatry has been extensively reviewed and found to be acceptable and generally equivalent to face-to-face care for many psychiatric conditions. 155,,156”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [155] 155. Gajaria A, Conn DK, Madan R. Telepsychiatry: effectiveness and feasibility. Smart Homecare Technol TeleHealth. 2015; 2015:59-67. source

      Checked before — its earlier verdict is held back until a new check runs.

    • cites [156] 156. Chakrabarti S. Usefulness of telepsychiatry: a critical evalua- tion of videoconferencing-based approaches. World J Psy- chiatry. 2015;5:286-304. source

  • May combine two claims.

    Premisecitation

    Another large primary care trial compared the effects of group MBCT and maintenance antidepressant therapy on time to relapse; while there were no significant differences between the 2 conditions, the risk of relapse was greater in those who had prematurely discontinued antidepressant treatment.

    “Another large primary care trial compared the effects of group MBCT and maintenance antidepressant therapy on time to relapse; while there were no significant differences between the 2 conditions, the risk of relapse was greater in those who had prematurely discontinued antidepressant treatment.69”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [69] 69. Kuyken W, Hayes R, Barrett B, et al. Effectiveness and cost- effectiveness of mindfulness-based cognitive therapy com- pared with maintenance antidepressant treatment in the pre- vention of depressive relapse or recurrence (PREVENT): a randomised controlled trial. Lancet. 2015;386:63-73. source

      Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingreasoning

    CBT remains the most established evidence-based, first-line treatment for depression, both acute and maintenance.

    “CBT remains the most established evidence-based, first-line treatment for depression, both acute and maintenance.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingnone given

    A key limitation of the STPP literature is the conflation of different models of psychodynamic therapy (PDT) into the broad term STPP, whereby no single model has a replicated large RCT with positive findings for MDD, unlike CBT and IPT.

    “A key limitation of the STPP literature is the conflation of different models of psychodynamic therapy (PDT) into the broad term STPP, whereby no single model has a replicated large RCT with positive findings for MDD, unlike CBT and IPT.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    Very few bibliotherapy trials have been published since 2009.

    “very few bibliotherapy trials have been published since 2009.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    PST has been tested most extensively in primary care settings in individuals with a variety of depressive symptoms spanning subclinical depression, adjustment disorders, and MDD, with clear efficacy in reducing depressive symptoms.

    “PST has been tested most extensively in primary care settings in individuals with a variety of depressive symptoms spanning subclinical depression, adjustment disorders, and MDD, with clear efficacy in reducing depressive symptoms.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    Although the meta-analysis aimed to examine the effect of any type of psychological treatment, the evidence was limited to CBT and MBCT.

    “Although the meta-analysis aimed to examine the effect of any type of psychological treatment, the evidence was limited to CBT and MBCT.161”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [161] 161. Guidi J, Fava GA, Fava M, et al. Efficacy of the sequential integration of psychotherapy and pharmacotherapy in major depressive disorder: a preliminary meta-analysis. Psychol Med. 2011;41:321-331. source

  • May combine two claims.

    Premisecitation

    Recruitment of individuals in standard MDD RCTs often excludes people with current suicidality, substance use, and other comorbidities, which limits the generalizability of these studies.

    “recruitment of individuals in standard MDD RCTs often excludes people with current suicidality, substance use, and other comorbidities.5 This limits the generalizability of these studies.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [5] 5. Zimmerman M, Mattia JI, Posternak MA. Are subjects in pharmacological treatment trials of depression representative of patients in routine clinical practice? Am J Psychiatry. 2002;159:469-473. source

  • May combine two claims.

    Premisecitation

    Men and women derive similar benefits from CBT and from antidepressants.

    “a large individual-level meta-analysis confirmed that men and women derive similar benefits from CBT and from antidepressants.11”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [11] 11. Cuijpers P, Weitz E, Twisk J, et al. Gender as predictor and moderator of outcome in cognitive behavior therapy and pharmacotherapy for adult depression: an ''individual patient data'' meta-analysis. Depress Anxiety. 2014;31: 941-951. source

  • May combine two claims.

    Premisecitation

    For ADHD, CBT can improve both depressive and ADHD symptoms.

    “For ADHD, CBT can improve both depressive and ADHD symptoms.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [22] 22. Bond DJ, Hadjipavlou G, Lam RW, et al. The Canadian Network for Mood and Anxiety Treatments (CANMAT) task force recommendations for the management of patients with mood disorders and comorbid attention- deficit/hyperactivity disorder. Ann Clin Psychiatry. 2012; 24:23-37. source

  • Classified as probably not a substantial claim.

    Premisecitation

    The best outcomes are likely to come from the concurrent use of evidence-based therapy relationships, not just evidence-based treatments.

    “concluded that the best outcomes are likely to come from the concurrent use of evidence-based therapy relationships, not just evidence-based treatments.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [45] 45. Norcross JC.Psychotherapy relationships that work: evidence-based responsiveness. 2nd ed. New York (NY): Oxford University Press; 2011.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    Three evidence-based common factors found to predict positive outcomes are establishing a strong therapeutic alliance, using empathy, and collecting client feedback.

    “Three evidence-based common factors found to predict positive outcomes are establishing a strong therapeutic alliance, using empathy, and collecting client feedback (Table 4).[46][47][48][49]”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [46] 46. Norcross JC, Lambert MJ. Psychotherapy relationships that work II. Psychotherapy. 2011;48:4-8. source
    • cites [47] 47. Norcross JC, Wampold BE. Evidence-based therapy relation- ships: research conclusions and clinical practices. Psychother- apy. 2011;48:98-102. source
    • cites [48] 48. Elliott R, Bohart AC, Watson JC, et al. Empathy. Psychother- apy (Chic). 2011;48:43-49. source

  • May combine two claims.

    Premisecitation

    Many pregnant women prefer psychological treatment and report fear of potential adverse effects of antidepressants on the developing fetus or newborn via lactation, general worries about negative outcome, fears of dependency, and balancing concerns about their own health or the fetus.

    “many pregnant women prefer psychological treatment and report fear of potential adverse effects of antidepressants on the developing fetus or on their newborn via lactation, general worries about a negative outcome, and fears of dependency as well as balancing concerns about their own health or the fetus.41,42”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [41] 41. Battle CL, Salisbury AL, Schofield CA, et al. Perinatal anti- depressant use: understanding women's preferences and con- cerns. J Psychiatr Pract. 2013;19:443-453. source
    • cites [42] 42. Walton GD, Ross LE, Stewart DE, et al. Decisional con- flict among women considering antidepressant medication use in pregnancy. Arch Womens Ment Health. 2014;17: 493-501. source

  • May combine two claims.

    Premisecitation

    When only bona-fide therapies were considered, there were no differences between CBT and IPT, but CBT was more effective than other psychotherapies considered as a group.

    “When only bona-fide therapies (defined as delivered by trained therapists, based on psychological principles, and designed to be a viable treatment) were considered, there were no differences between CBT and IPT, but CBT was more effective than other psychotherapies considered as a group 59”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [59] 59. Tolin DF. Is cognitive-behavioral therapy more effective than other therapies? A meta-analytic review. Clin Psychol Rev. 2010;30:710-720. source

  • May combine two claims.

    Premisecitation

    The evidence base for STPP has expanded with recent studies, including comparisons with CBT and antidepressant medication and a recently updated meta-analysis.

    “The evidence base for STPP has expanded with recent studies, including comparisons with CBT 72 and antidepressant medication 73 and a recently updated meta-analysis.61”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [72] 72. Driessen E, Van HL, Don FJ, et al. The efficacy of cognitive- behavioral therapy and psychodynamic therapy in the outpa- tient treatment of major depression: a randomized clinical trial. Am J Psychiatry. 2013;170:1041-1050. source
    • cites [73] 73. Barber JP, Barrett MS, Gallop R, et al. Short-term dynamic psychotherapy versus pharmacotherapy for major depressive disorder: a randomized, placebo-controlled trial. J Clin Psy- chiatry. 2012;73:66-73. source
    • cites [61] 61. Driessen E, Hegelmaier LM, Abbass AA, et al. The efficacy of short-term psychodynamic psychotherapy for depression: a meta-analysis update. Clin Psychol Rev. 2015;42:1-15. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    Given the gap between needed and available psychological treatments, group psychotherapy could improve access to treatment.

    “given the gap between needed and available psychological treatments, group psychotherapy could improve access to treatment.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: There is a gap between needed and available psychological treatments.

  • May combine two claims.

    Premisecitation

    Studies comparing 8 versus 16 or more sessions are rare but suggestive of similar effectiveness.

    “Studies comparing 8 versus 16 or more sessions are rare but suggestive of similar effectiveness.[84][85][86]”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [84] 84. Dekker J, Molenaar PJ, Kool S, et al. Dose-effect relations in time-limited combined psycho-pharmacological treatment for depression. Psychol Med. 2005;35:47-58. source
    • cites [85] 85. Molenaar PJ, Boom Y, Peen J, et al. Is there a dose-effect relationship between the number of psychotherapy sessions and improvement of social functioning? Br J Clin Psychol. 2011;50:268-282. source
    • cites [86] 86. Dimidjian S, Hollon SD, Dobson KS, et al. Randomized trial of behavioral activation, cognitive therapy, and anti- depressant medication in the acute treatment of adults with major depression. J Consult Clin Psychol. 2006; 74:658-670. source

  • May combine two claims.

    Premisecitation

    A meta-analysis of 10 trials demonstrated a reduction in the risk of relapse by 21% in the first year and by 28% in the first 2 years.

    “A meta-analysis of 10 trials demonstrated a reduction in the risk of relapse by 21% in the first year and by 28% in the first 2 years.90”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [90] 90. Clarke K, Mayo-Wilson E, Kenny J, et al. Can non- pharmacological interventions prevent relapse in adults who have recovered from depression? A systematic review and meta-analysis of randomised controlled trials. Clin Psychol Rev. 2015;39:58-70. source

  • May combine two claims.

    Interpretationreasoning

    There is insufficient evidence to recommend STPP or PDT as a maintenance treatment for MDD.

    “There is insufficient evidence to recommend STPP or PDT as a maintenance treatment for MDD.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    CBASP was developed specifically for the treatment of chronic depression.

    “CBASP was developed specifically for the treatment of chronic depression.113”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [113] 113. McCullough JP. Treatment for chronic depression using cog- nitive behavioral analysis system of psychotherapy (CBASP). J Clin Psychol. 2003;59:833-846. source

  • May combine two claims.

    Premisecitation

    Two separate meta-analyses found that the use of PST as an acute treatment for late life depression resulted in a significant reduction of depressive symptoms as well as disability in comparison to control treatments.

    “Two separate meta-analyses found that the use of PST as an acute treatment for late life depression resulted in a significant reduction of depressive symptoms as well as disability in comparison to control treatments.138,140”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [138] 138. Bell AC, D'Zurilla TJ. Problem-solving therapy for depres- sion: a meta-analysis. Clin Psychol Rev. 2009;29:348-353. source
    • cites [140] 140. Kirkham JG, Choi N, Seitz DP. Meta-analysis of problem solving therapy for the treatment of major depressive disorder in older adults. Int J Geriatr Psychiatry. 2015;31:526-535. source

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    The rationale for BA is that depression is caused and maintained by escape and avoidance of aversive emotions and stimuli that become self-reinforced and also prevents positive reinforcement of nondepressive behaviour, consequently causing longstanding patterns of inertia, avoidance, and social withdrawal.

    “The rationale for BA is that depression is caused and maintained by escape and avoidance of aversive emotions and stimuli that become self-reinforced and also prevents positive reinforcement of nondepressive behaviour, consequently causing longstanding patterns of inertia, avoidance, and social withdrawal.123”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [123] 123. Ferster CB. A functional analysis of depression. Am Psychol. 1973;28:857-870. source

  • May combine two claims.

    Premisecitation

    One meta-analysis (34 studies, N > 2000 patients with depressive symptoms, but not necessarily MDD) found similar large effect sizes for BA and CBT compared to control conditions, as well as a similar effect to CBT.

    “One meta-analysis (34 studies, N > 2000 patients with depressive symptoms, but not necessarily MDD) 127 found similar large effect sizes for BA and CBT compared to control conditions, as well as a similar effect to CBT.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [127] 127. Mazzucchelli T, Kane R, Rees C. Behavioral activation treat- ments for depression in adults: a meta-analysis and review. Clin Psychol Sci Pract. 2009;16:383-411. source

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Level 2 Evidence supports PST as a second-line acute treatment in primary care and geriatric depression.

    “PST is recommended as a second-line acute treatment in primary care and geriatric depression (Level 2 Evidence)”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation

    Telephone-delivered CBT has Level 1 Evidence, while other therapies have Level 2 Evidence.

    “Collectively, telephone-delivered CBT has Level 1 Evidence, while other therapies have Level 2 Evidence”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    In one of the first large trials (600 patients starting antidepressants in primary care offices), both 8-session CBT and disease management by phone improved clinical efficacy and satisfaction, compared to medication alone.

    “In one of the first large trials (600 patients starting antidepressants in primary care offices), both 8-session CBT and disease management by phone improved clinical efficacy and satisfaction, compared to medication alone.79”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [79] 79. Simon GE, Ludman EJ, Tutty S, et al. Telephone psychother- apy and telephone care management for primary care patients starting antidepressant treatment: a randomized controlled trial. JAMA. 2004;292:935-942. source

  • May combine two claims.

    Premisecitation

    A large pragmatic trial found that a course of up to 18 sessions of face-to-face individual CBT significantly reduced depressive symptoms and increased the likelihood of therapeutic response to antidepressants in treatment-resistant depression.

    “a large pragmatic trial found that a course of up to 18 sessions of face-to-face individual CBT significantly reduced depressive symptoms and increased the likelihood of therapeutic response to antidepressants in treatment-resistant depression.63”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [63] 63. Wiles N, Thomas L, Abel A, et al. Cognitive behavioural therapy as an adjunct to pharmacotherapy for primary care based patients with treatment resistant depression: results of the CoBalT randomised controlled trial. Lancet. 2013;381: 375-384. source

  • May combine two claims.

    Premisecitation

    When Internet therapy is guided by a clinician, both adherence and efficacy are much more substantial.

    “When the Internet therapy is guided by a clinician, both adherence and efficacy are much more substantial.88”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [88] 88. Cuijpers P. Psychotherapies for adult depression: recent developments. Curr Opin Psychiatry. 2015;28:24-29. source
45 of 45

  • The paper relies on this without support.

    Older patients with depression are more vulnerable to medication side effects and drug interactions because many may already be taking multiple medications for comorbid medical disorders.

    “older patients with depression are more vulnerable to medication side effects and drug interactions, as many may already be taking multiple medications for comorbid medical disorders.”

  • The paper relies on this without support.

    The evidence for psychological therapies for depression is based on studies with highly competent therapists.

    “Most importantly, the evidence for psychological therapies for depression is based on studies with highly competent therapists”

  • The paper relies on this without support.

    All high-quality evidence in psychotherapy research is based on studies where extensively trained therapists receive regular supervision and adhere to principles of the given therapeutic model with high fidelity.

    “All high-quality evidence in psychotherapy research is based on studies where extensively trained therapists receive regular supervision and adhere to principles of the given therapeutic model with high fidelity.”

  • The paper relies on this without support.

    Comparisons of different psychological treatments are fewer in number and quality, and are complicated by methodological challenges including lack of blinding and allegiance to a particular model.

    “Comparisons of different psychological treatments are fewer in number and quality, as well as complicated by methodological challenges, including lack of blinding and the effects of allegiance to a particular model.”

  • The paper relies on this without support.

    There is a gap between needed and available psychological treatments.

    “given the gap between needed and available psychological treatments”

  • The paper relies on this without support.

    The core of psychotherapy remains unchanged when delivered in a group format.

    “the core of the psychotherapy remains unchanged, so group interventions are not evaluated in these guidelines as a separate ''group therapy.''”

  • The paper relies on this without support.

    Context-specific therapies do not generalize to the average person with depression.

    “context-specific therapies (such as marital therapy for MDD coinciding with a severe marital dispute) are not evaluated, since such therapies do not generalize to the average person with depression.”

  • The paper relies on this without support.

    MI has been used in conjunction with CBT, IPT, or medications to improve treatment engagement or adherence and for treatment of depression and comorbid substance misuse.

    “it has been used in conjunction with CBT, IPT, or medications to improve treatment engagement or adherence and for treatment of depression and comorbid substance misuse.”

  • The paper relies on this without support.

    Peer support can be beneficial either alone or as a complement to clinical care.

    “Peer support can be beneficial either alone or as a complement to clinical care.”

  • The paper relies on this without support.

    Bibliotherapy has practical utility due to ease of use and low cost.

    “bibliotherapy has practical utility due to ease of use and low cost”
10 of 10

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?

  • MBCT is recommended in national clinical guidelines for relapse prevention in several countries and has been endorsed by the American Psychiatric Association.

    “As such, MBCT is included in the clinical guidelines as a recommended option for relapse prevention in a number of different countries, including the UK, Netherlands, Canada, Australia and New Zealand (Malhi et al. 2015; NICE 2009; Parikh et al. 2016), and has been endorsed by the American Psychiatric Association (Lu 2015).”

    From The Effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) in Real-World Healthcare Services (2020) · cites this paper as Parikh et al. 2016

  • Individuals with inflammatory and metabolic comorbidities have greater risks of mood disorders and cognitive dysfunction.

    “Indeed, individuals with inflammatory and metabolic comorbidities are at greater risks of mood disorders and cognitive dysfunction.13,14”

    From Cognitive Impairment in Major Depressive Disorder (2019) · cites this paper as [14]

  • A recent meta-analysis showed that reductions in cognitive function predict poorer functional and metabolic outcomes.

    “Moreover, evidence from a recent meta-analysis showed that reductions in cognitive function are predictive of poorer functional and metabolic outcomes.14”

    From Cognitive Impairment in Major Depressive Disorder (2019) · cites this paper as [14]

  • CBT is the first-line psychological treatment recommended by guidelines for depression, anxiety, and PTSD.

    “CBT is the first-line psychological treatment recommended by the guidelines of depression, anxiety, and PTSD (ie, Canadian Network for Mood and Anxiety Treatments and National Institute of Health and Care Excellence guideline [49,50].”

    From The Efficacy of Computerized Cognitive Behavioral Therapy for Depressive and Anxiety Symptoms in Patients With COVID-19: Randomized Controlled Trial (2021) · cites this paper as [49]

Self-check

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

Each contradiction between two passages listed here was confirmed by an independent check.

  • Conflicting maintenance recommendation for long-term psychodynamic therapy

    Major

    The text says there is insufficient evidence to recommend psychodynamic therapy for maintenance treatment, but Table 5 gives long-term psychodynamic therapy a third-line maintenance recommendation.

1 of 1

Cited works that were retracted

Works this paper cites that were later retracted, from the retraction notices publishers deposit. Major when the notice came out before this paper was published.

  • Cites a retracted work: 10.1001/jamapsychiatry.2014.1054

    Info

    The cited work was retracted; the date of the notice is not on record.

    Cited work 10.1001/jamapsychiatry.2014.1054 · retraction date not known · this paper published 2016-08-11

1 of 1

Cites

1 retracted

Flagged first, then by citations

Research works printed but not linked: 3

  1. Leszcz M, Pain C, Hunter J, . Psychotherapy essentials to go: achieving psychotherapy effectiveness. New York (NY): Norton; 2015.
  2. 10.1192/bjp.bp.112.113696 · DOI · Paper page
  3. Baldwin SA Imel ZE. Therapist effects: findings and methods. In: Lambert MJ editor. Bergin and Garfield’s handbook of psychotherapy and behavior changes. 6th ed. New York (NY): John Wiley; 2013. pp. 258–297.

Cited by

Sorted by citations

Related

Authors
Parikh, S. V., Quilty, L. C., Ravitz, P., Rosenbluth, M., Pavlova, B., Grigoriadis, S., Velyvis, V., Kennedy, S. H., Lam, R. W., MacQueen, G. M., Milev, R. V., Ravindran, A. V., Uher, R., & the CANMAT Depression Work Group
Affiliations
  • University of Toronto (CA)
  • Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia
  • CBT Associates, Toronto, Ontario
  • University of British Columbia (CA)
  • University of Calgary (CA)
  • Queen's University (CA)
  • Dalhousie University (CA)
ORCID
Venue
The Canadian Journal of Psychiatry
Publisher
SAGE Publications
Published
2016-08-11
Volume
61
Issue
9
Pages
524-539
ISSN
  • 0706-7437 (ISSN-L)
  • 1497-0015
DOI
10.1177/0706743716659418
PMC
PMC4994791
OpenAlex
W2485472464
Cited by
562
References
264
Citations by year
2026: 15 · 2025: 18 · 2024: 54 · 2023: 45 · 2022: 77 · 2021: 82 · 2020: 101 · 2019: 73 · 2018: 49 · 2017: 39 · 2016: 9
FWCI
6.46
Type
journal article
Language
en
Open access
Licence
journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations
  • The Canadian Journal of Psychiatry (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Bristol-Myers Squibb
  • Eli Lilly and Company
  • Pfizer
  • Sunovion
  • Valeant Pharmaceuticals International
  • Canadian Network for Mood and Anxiety Treatments
  • Queen's University
  • Grand Challenges Canada
  • Ministero dello Sviluppo Economico
  • Vancouver Coastal Health Research Institute
  • H. Lundbeck A/S
  • St. Jude Medical
  • Allergan
  • University Health Network Foundation
  • Canadian Institutes of Health Research
Topics
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
  • Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
Keywords
major depressive disorder, neurostimulation, transcranial direct current stimulation, repetitive transcranial magnetic stimulation, electroconvulsive therapy, magnetic seizure therapy, vagus nerve stimulation, deep brain stimulation, treatment-resistant depression, antidepressant-refractory depression, CANMAT guidelines
MeSH terms
Canada, Major Depressive Disorder, Humans, Psychotherapy, Societies, Medical, Practice Guidelines as Topic, Evidence-Based Medicine

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.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-11.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-11.

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Statistics and arithmetic are recomputed, not judged.

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