Effectiveness and Durability of Psychological Interventions for Depressive Symptoms in Patients With Depressive Disorders: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials

Background Psychological interventions (PIs) are effective for depressive disorders (DDs). However, comparative evidence regarding their effectiveness and durability in reducing depressive symptoms (DSs) remains limited. Objectives To compare the effectiveness and durability of PIs for DSs in patients with DDs. Methods Five databases were searched for RCTs comparing PIs for DDs, up to June 23, 2024. A random-effects NMA synthesized changes in DSs at post-treatment and follow-up. Risk of bias was assessed using RoB 2. Results Of 12,076 records identified, 71 RCTs were included. All PIs except dialectical behavior therapy (DBT) were more effective than TAU for managing DSs at post-treatment (SMDs: −0.58 to −1.59). Problem-solving therapy (PST) and behavioral activation (BA) showed the highest short-term efficacy, followed by mindfulness-based cognitive therapy (MBCT), although PST evidence was based on a single study. At follow-up, IPT (SMD = −0.91), BA (−0.81), and CBT (−0.68) showed durable treatment effects. Conclusions BA and MBCT were more effective PIs for DSs reduction in the short term. IPT, BA, and CBT demonstrated durable treatment effects in patients with DDs. However, these findings should be interpreted with caution due to the heterogeneous TAU comparators and the low-to-very-low certainty of evidence.