Table 1.
Major Depressive Disorder (Adult and Geriatric)
| Study | Treatment/s | Number of Sessions | Control Condition/s | Age of subjects | Sample size | Diagnosis | Setting | Therapists' qualification | Results |
|---|---|---|---|---|---|---|---|---|---|
| Dynamic: | |||||||||
| Covi et al 1974[15] | Dynamic psychotherapy vs brief supportive contacts crossed with medication vs placebo | 16 90-minute group sessions over 17 weeks | Pill-placebo plus brief supportive contacts | Adults aged 20-50 | 207 assigned of whom 146 completed | Depressed outpatients with elevated symptoms | Outpatient research clinic at university medical center | Experienced psychiatrists | Dynamic psychotherapy less efficacious than medications and no better than pill-placebo and did nothing to enhance the efficacy of medications |
| McLean & Hakstian 1979[14] | Dynamic psychotherapy vs contingency management (BT) vs medication | 10 weekly 60-minute sessions | Relaxation therapy (RT) | Adult aged 20-60 | 196 assigned of whom 154 completed | Feighner criteria definite depressive syndrome | Outpatient research clinic at university medical center | Psychiatrists and psychologists with greater or lesser experience | Dynamic psychotherapy less efficacious than other conditions with BT most efficacious of all |
| Gallagher & Thompson 1982[29] | Dynamic psychotherapy vs cognitive therapy (CT) vs behavior therapy (BT) | 16 sessions 12 weeks (1 year naturalistic follow-up) | None | Elderly aged 55 plus | 30 assigned (attrition not reported) | RDC MDD | Geriatric clinic at university medical center | Pre- and post-doctoral psychologists | No differences in terms of acute response although better maintenance of gains for CT or BT than for dynamic psychotherapy |
| Kornblith et al 1983[18] | Dynamic psychotherapy vs three different versions of self-control therapy (SCT) | 12 weekly group sessions | None | Adult women aged 18-60 | 49 assigned of whom 39 completed | RDC MDD | Outpatient research clinic in academic psychology department | Graduate students in psychology (SCT) and MSW candidate (dynamic) | No differences between the groups |
| Hersen et al 1984[17] | Dynamic psychotherapy vs social skills training crossed with medication vs placebo | 12 weekly sessions (plus 6-8 subsequent visits over 6 months) | None | Adult women aged 21-60 | 120 assigned of whom 82 completed | Feighner criteria primary depression (DSM-III MDD) | Outpatient research clinic at university medical center | Experienced psychologists (psychotherapy conditions) and medical clinic personal (medications) | No differences with respect to acute response |
| Steuer et al 1984[33] | Dynamic psychotherapy vs cognitive behavior therapy (CT) | 46 two-hour group sessions over 9 months | None | Elderly aged 55 plus | 35 assigned of whom 20 completed | DSM-III MDD | Geriatric clinic at VA medical center | Pre/post-doctoral psychologists and masters level social workers | CT better than dynamic psychotherapy with respect to acute response |
| Covi et al 1987[16] | Dynamic psychotherapy vs cognitive therapy (CT) with and without medications | 16 group sessions over 14 weeks then 4 weeks of individual sessions | None | Adults aged 18-70 | 90 assigned of whom 70 completed | RDC MDD | Outpatient research clinic at university medical center | Psychiatrist and psychologist | Dynamic psychotherapy less efficacious than CT with or without medications |
| Thompson et al 1987[30] | Dynamic psychotherapy vs cognitive therapy (CT) vs behavior therapy (BT) | 16-20 sessions in 12 weeks | 6-week delayed treatment control | Elderly aged 60 plus | 109 assigned of whom 91 completed | RDC MDD | Geriatric clinic at VA medical center | Doctoral level clinical psychologists | Active treatments did not differ and better than delayed treatment when pooled |
| Gallagher-Thompson et al 1990[31] | No differences in follow-up | ||||||||
| Gallagher-Thompson & Steffen, 1994[32] | Brief psychodynamic psychotherapy vs cognitive therapy (CT) | 16-20 sessions over 12 weeks | None | Adult caregivers of frail elderly | 66 assigned of whom 52 completed | RDC Major, Minor, or Intermittent Depression | Geriatric clinic at VA medical center | Doctoral level clinical psychologists and masters level social workers | Short-term caregivers did better in dynamic and long-term caregivers better in CT |
| Shapiro et al 1994[19] | Dynamic interpersonal psychotherapy vs cognitive behavior therapy (CBT) | 8 or 16 sessions | None | Adults mean age 40 (± 10) | 150 assigned of whom 117 completed | DSM-III MDD | Research clinic | Clinical psychologists | No differences on most measures (CBT better on one) but longer treatment better for more severe |
| Barkham et al 1996[20] | 36 additional patients added | ||||||||
| De Jonghe et al 2001[24] | Dynamic psychotherapy plus medication vs medication alone | 16 sessions (weekly for 8 weeks then biweekly thereafter) | None | Adults aged 18-60 | 167 assigned of whom 129 completed | DSM-III-R MDD | Outpatient research clinic at university medical center | Experienced psychotherapists (discipline unspecified) and psychiatric residents | Combined treatment reduced attrition and thereby increased overall rates of recovery over ADM alone |
| Kool et al 2003[25] | |||||||||
| Combined treatment better than medications alone for patients with personality disorders | |||||||||
| Burnand et al 2002[22] | Dynamic psychotherapy plus medication vs supportive care plus medication | 10 week treatment program (session frequency not stated) | None | Adults aged 20-65 | 95 assigned of whom 74 completed | DSM-IV MDD | Community mental health center | Experienced research nurses under psychoanalytic supervision | No differences on symptom measures but dynamic psychotherapy reduced rates of MDD and promoted work adjustment better than supportive care |
| Cooper et al 2003[21] | Dynamic therapy vs cognitive behavior therapy vs non-directive counseling | Weekly sessions from week 8 to18 postpartum | Routine primary care | Adult women aged 17-42 | 193 assigned of whom 171 completed | DSM-III-R MDD post-partum women | Patient homes | Specialists in the research treatment and non-specialists | Active treatments all superior to control at 4.5 months but not at 9 months post-partum and only dynamic reduced rates of diagnosed depression relative to routine care |
| Maina et al 2007[27] | Brief dynamic therapy plus antidepressant medications (BDT/ADM) | 15 to 30 sessions over 6 months of active treatment followed by 6 months of medication continuation | Brief supportive psychotherapy plus antidepressant medications (BSP/ADM_ | Adults aged 18-65 | 148 assigned of whom*** completed | DSM-IV MDD single episode and presence of focal problem or precipitant life event | Research clinic at university medical center | Psychiatrists who had completed personal training in psychodynamic psychotherapy | Adding BDT to ADM no better than adding BSP at end of treatment but BDT showed continued improvement across 6-month continuation phase |
| Maina et al 2009[28] | Prior BDT reduced rates of recurrence across 48 month treatment-free follow-up | ||||||||
| Dekker et al., 2008[26] | Short-term psychodynamic supportive psychotherapy (SPSP) vs antidepressant medication (ADM) | 8 weekly sessions | None | Adults aged 18-65 | 141 assigned of whom 103 completed treatment | DSM-IV MDD | Community mental health center | Trained psychiatrists and psychotherapists not otherwise specified | Medication superior to SPSP but differences diminishing from weeks 4 through 8 |
| Salminen et al., 2008[23] | Short-term psychodynamic psychotherapy (STPP) vs medication | 16 weekly session | None | Adults aged 20-60 | 51 assigned of whom 40 completed | DSM-IV MDD (mild and moderate) | General practice setting | Experienced psychiatrists and psychologists with two years training in STDP | No differences between groups on any outcomes |
| Interpersonal: | |||||||||
| Klerman et al 1974 (relapse)[36] | Interpersonal psychotherapy (IPT) vs medication vs combined treatment | 32-36 weekly sessions in 8 months | Pill-placebo vs no pill (alone and combined with IPT) | Adult women with a median age in the late 30's and range unspecified | 150 assigned of whom 139 completed | DSM-II neurotic depression (with bipolar) | Outpatient research clinics at university medical centers | Masters' level social workers | IPT as efficacious as medications in preventing relapse if provided without pill-placebo |
| Weissman et al 1974 (social adjustment)[37] | IPT had delayed effect on enhance social adjustment | ||||||||
| Weissman et al 1979 (acute)[38] | Interpersonal psychotherapy (IPT) vs medications vs combined treatment | 16 sessions 16 weeks | Treatment-on-demand nonspecific control | Adults aged 18-65 | 96 assigned of whom 81 completed | RDC MDD (primary) | Outpatient research clinics at university medical centers | Psychiatrists | IPT as efficacious as medications and combined better still with all superior to nonspecific control (acute) |
| DiMascio et al 1979 (acute)[39] | |||||||||
| Weissman et al 1981 (social adjustment / relapse prevention)[40] | 1 year naturalistic follow-up | IPT again had delayed effect on social adjustment but not relapse | |||||||
| Elkin et al 1989, 1995(acute)[41,42] | Interpersonal psychotherapy (IPT) vs cognitive therapy (CT) vs medication | 16-20 sessions over 16 weeks | Pill-placebo | Adults with a mean age of 35 ± 8.5 years | 250 assigned of whom 155 completed | RDC MDD (primary) | Outpatient research clinics at university medical centers | Psychiatrists and doctoral level clinical psychologists | IPT or medications better than CT or pill-placebo among more severe patients with no differences among less severe patients (acute) |
| Watkins et al., 1993[43] | |||||||||
| Drugs faster than IPT or CT | |||||||||
| Shea et al., 1992 (relapse prevention)[99] | Prior CBT vs prior IPT vs prior medications | 18 month naturalistic follow-up | Medication withdrawal | No differences with respect to relapse prevention | |||||
| Frank et al 1990[59] | Maintenance phase interpersonal psychotherapy (IPT) vs maintenance medication vs combined treatment | 36 monthly sessions (after up to 36 weeks treatment with IPT plus drugs) | Pill-placebo control (alone and combined with IPT) | Adults aged 21-65 | 128 assigned of whom 106 completed | RDC MDD with history of recurrence and currently in recovery | Outpatient research clinic at university medical center | Social workers, psychologists, or nurse clinicians with masters or doctorates | IPT more efficacious than pill-placebo control but less efficacious than and did little to enhance the efficacy of maintenance medication in prevention of recurrence |
| Schulberg et al 1996[52] | Interpersonal psychotherapy (IPT) vs medication | 16 weekly sessions (and 4 monthly sessions) | Treatment as usual (TAU) | Adults aged 18-64 | 276 assigned of whom 150 completed | DSM-III-R MDD | Primary care setting | Psychiatrists and clinical psychologists | IPT as efficacious as medications and both superior to TAU |
| Markowitz et al 1998[49] | Interpersonal psychotherapy (IPT) vs cognitive behavior therapy (CBT) vs medications | 16 sessions 17 weeks | Supportive therapy | Adults (HIV) aged 24-59 | 101 assigned of whom 69 completed | HIV+ with depression (about half met for DSM III-R MDD) | Outpatient research clinic at university medical center | Psychiatrists and social workers (IPT) and clinical psychologists (CBT) | IPT or medications both produced better acute response than either CBT or supportive psychotherapy |
| Reynolds, Frank et al 1999[61] | Maintenance phase interpersonal psychotherapy (IPT) vs maintenance medication vs combined treatment | 36 monthly sessions (after up to 36 weeks of combined treatment) | Pill-placebo control (alone and combined with IPT) | Elderly aged 60 or older | 107 assigned of whom 96 completed | RDC MDD with history of recurrence and currently in recovery | Outpatient research clinic at university medical center | Masters level social workers and masters and doctoral level psychologists | IPT more efficacious than pill-placebo control and comparable to and enhanced the efficacy of maintenance medications in prevention of recurrence |
| Reynolds, Miller et al 1999[57] | Interpersonal psychotherapy (IPT) vs medication vs combined treatment | 16 sessions over 16 weeks | Pill-placebo control (alone and combined with IPT) | Elderly aged 50 or older | 80 assigned of whom 73 completed | RDC MDD in recently bereaved | Outpatient research clinic at university medical center | Psychiatrists | IPT no better than placebo and did nothing to enhance the efficacy of medications |
| O'Hara et al., 2000[44] | Interpersonal psychotherapy (IPT) | 12 weekly 60-minute sessions | Wait list control | Adult women aged 18 and above | 120 assigned of whom 99 completed | DSM-IV MDD in postpartum females | Private practice settings | Doctoral level clinical or counseling psychologists | IPT reduced depressive symptoms and improved social adjustment |
| Judd et al 2001[53] | Interpersonal psychotherapy (IPT) plus medication | 12 sessions | Treatment as usual (TAU) plus ADM | Adults aged 18-65 | 32 assigned of whom 28 completed | DSM-IV MDD | General practice | General practitioners | Depression improved in both treatments but no differences between conditions |
| Bolton et al., 2003[50] | Interpersonal psychotherapy (IPT) | 16 weekly 90-minute group sessions | No treatment | Adults | 341 assigned of whom 224 completed | DSM-IV MDD (and sub-thresh) | Rural Ugandan villages | Indigenous nonprofessionals trained in IPT | Group IPT superior to no treatment control |
| Bass et al., 2006[51] | Differences favoring IPT sustained over 6 month follow-up | ||||||||
| Spinelli & Endicott 2003[45] | Interpersonal psychotherapy (IPT) modified for antepartum depression | 16 weekly sessions | Didactic parent education | Adult women aged 18-45 | 50 assigned of whom 38 completed | DSM-IV MDD in pregnant women | Outpatient research clinic | Experienced therapists | IPT produced greater rate of improvement than did didactic parenting control (60% vs 15%) |
| Reynolds et al 2006[62] | Maintenance phase interpersonal psychotherapy (IPT) vs clinical management crossed with maintenance medications (ADM) vs pill-placebo | Monthly maintenance sessions for two years | Pill-placebo control (alone and combined with IPT) | Geriatric aged 70 and above | 116 assigned of whom 90 completed maintenance phase | DSM-IV MDD and response to combined treatment | Outpatient research clinic | Experienced IPT therapists (nurses, social workers, and psychologists) | ADM better than placebo with or without IPT but no effect for IPT with or without medications |
| Carreira et al 2009[63] | IPT protects against recurrence in cognitively impaired unmedicated patients | ||||||||
| Van Schaik et al 2006[58] | Interpersonal psychotherapy (IPT) | 10 sessions over 5 months | Treatment as usual (TAU) | Geriatric aged 55 and older | 143 assigned of whom 120 completed | PRIME-MD depression | General practice settings (x12) | Psychologists and psychiatric nurses | IPT associated with fewer patients who still met criteria for depression than TAU but no differences in more stringent rates of remission |
| Luty et al 2007 (acute)[46] | Interpersonal psychotherapy (IPT) vs cognitive behavior therapy (CBT) | 8-19 sessions over 16-20 weeks | None | Adults aged 18 and above | 177 assigned of whom 159 completed | DSM-IV MDD | Outpatient research clinic | Experienced therapists with MD or PhD | CBT better than IPT at level of nonsignificant trend in full sample and superior for more severe or Axis II patients |
| Joyce et al 2007 (personality)[47] | |||||||||
| Schramm et al 2007[54] | Interpersonal psychotherapy plus antidepressant medication (Comb) vs antidepressant medication alone | 15 individual and 8 group sessions over 5 weeks | None | Adults aged 18-65 | 130 assigned of whom 105 completed | DSM-IV MDD (included bipolar II) | Inpatient psychiatric hospital | Psychiatrists and psychologists who completed 3-year training program in IPT | Combined treatment superior to medications alone |
| Schramm et al 2008[55] | Indications of enduring effect for prior IPT | ||||||||
| Marshall et al 2008[48] | Interpersonal psychotherapy (IPT) vs cognitive behavior therapy (CBT) vs antidepressant medications | 16 weekly sessions | None | Adults (age unspecified) | 159 assigned of whom 102 completed | DSM-IV MDD | University affiliated research clinic | Doctoral level psychologists and pre-doctoral psychology graduate students | IPT less efficacious than medication with CT not differing from either |
| Swartz et al 2008[56] | Interpersonal psychotherapy for mothers of children with psychiatric illnesses (IPT-MOMS) | Engagement interview followed by 8 sessions of IPT | Treatment as usual (TAU) | Adults aged 18-65 | 65 assigned of whom 47 completed | DSM-IV MDD | Pediatric mental health clinic | Masters or doctoral level therapists with degrees in social work, nursing, psychology, or psychiatry | IPT-MOMS more efficacious than TAU in terms of depressive symptoms and global functioning in moms and depression in offspring |
| Cognitive: | |||||||||
| Rush et al 1977 (acute)[66] | Cognitive therapy (CT) vs antidepressant medication (ADM) | 20 sessions 12 weeks | None | Adults aged 18-65 | 41 assigned of whom 32 completed | Feighner definite depression (DSM-II neurotic) | Outpatient research clinic at university medical center | Psychiatrists, psychiatric residents and pre- and post-doctoral psychologists | CBT better than ADM (acute) |
| Kovacs et al 1981 (relapse)[93] | Prior CBT | 12 month naturalistic follow-up | Medication withdrawal | Prior CBT better than prior ADM at preventing relapse | |||||
| Blackburn et al 1981 (acute)[67] | Cognitive therapy (CT) vs antidepressant medication (ADM) vs combined | 15-20 sessions in 12-20 weeks | None | Adults aged 18-65 | 88 assigned of whom 64 completed | RDC primary major depression | Outpatient research clinic at university medical center and general practice clinic | Doctoral level clinical psychologists | CBT (with or without ADM) better than ADM alone in community sample with combined better than either monotherapy in psychiatric setting (acute) |
| Blackburn et al 1986 (relapse / recurrence)[94] | Prior CBT with boosters through month six | 24 month naturalistic follow-up | Medication withdrawal after month six | Prior CBT (with or without ADM) better than prior ADM preventing recurrence | |||||
| Murphy et al 1984 (acute)[68] | Cognitive therapy (CT) vs antidepressant medication (ADM) vs combined | 20 sessions in 12 weeks | Placebo (only in combination with CBT) | Adults aged 18-60 | 95 assigned of whom 70 completed | Feighner definite depression RDC MDD primary | Outpatient research clinic at university medical center | Psychiatrists, psychiatric residents and pre- and post-doctoral psychologists | No differences between conditions (acute) |
| Simons et al 1986 (relapse)[95] | Prior CBT | 12 month naturalistic follow-up | Medication withdrawal | Prior CBT better than prior ADM at preventing relapse | |||||
| Teasdale et al 1984[87] | Cognitive therapy (CT) added to treatment as usual | 20 sessions over 12 weeks | Treatment-as-usual including medications (TAU) | Adults aged 18-60 | 44 assigned of whom 34 completed | RDC MDD | General practice | Doctoral level clinical psychologists trained in CT at Center for Cognitive Therapy | Adding CT enhanced the effects of TAU |
| Miller et al., 1989[84] | Cognitive therapy plus antidepressant medications (CT/ADM) vs behavior therapy plus antidepressant medications (BT/ADM) vs antidepressant medications (ADM) | Daily sessions during inpatient stay and then 20 weekly outpatient sessions | None | Adults with a mean age in the mid-to-late 30's | 46 assigned of whom 32 completed | DIS MDD | Inpatient medical setting | Experienced clinical psychologists (CT and BT) and research psychiatrists (ADM) | CT and BT both enhanced the efficacy of ADM alone although differences did not emerge until after discharge from inpatient setting |
| Bower et al 1990[85] | Cognitive therapy plus antidepressant medications (CT/ADM) vs behavior therapy plus antidepressant medications (BT/ADM) vs antidepressant medications (ADM) | 12 session in 30 days | None | Adults aged 18-60 | 30 assigned of whom 30 completed | DSM-III MDD | Inpatient medical setting | Single experienced clinical psychologist (study author) | CT and BT each enhanced efficacy of ADM |
| Selmi et al 1990[129] | Computer-administered cognitive behavioral therapy (CaCBT) vs therapist-administered CBT | 6 weekly sessions | Wait list | Adults with mean age in late 20's | 36 assigned of whom 36 completed | RDC major, minor, or intermittent depression | Outpatient research clinic at university medical center | Graduate students in clinical psychology | Computer-assisted CBT as efficacious as therapist-administered CBT and both superior to wait list |
| Hollon et al 1992 (acute)[70] | Cognitive therapy (CT) vs antidepressant medication (ADM) vs combined | 20 sessions in 12 weeks | None (acute) | Adults aged 18-65 | 107 assigned of whom 64 completed | RDC primary major depressive disorder | Outpatient research clinic at medical center and community | Doctoral level psychologist and ICSW level social workers | No differences between conditions (acute) |
| Evans et al 1992 (relapse)[96] | Prior CBT vs continue ADM | 24 month naturalistic follow-up | Medication withdrawal | mental health clinic | Prior CBT as efficacious as continued ADM and better than ADM withdrawal at preventing relapse | ||||
| Scott & Freeman 1992[89] | Cognitive behavior therapy (CBT) vs antidepressant medication (ADM) vs social work counseling (SWC) | 16 weekly sessions | Treatment-as-usual (TAU) | Adults aged 18-65 | 121 assigned of whom 105 completed | DSM-III MDD | General practice clinics | Clinical psychologists (CBT) and social workers (SWC) | Few differences among the conditions but those that were evident tended to favor social work counseling |
| Fava et al., 1994[100] | WBT added to ADM vs ADM alone in recovered patients with history of recurrence | 10 sessions in 20 weeks to 24 month naturalistic follow-up | Medication withdrawal during 24 month naturalistic follow-up | Adults with mean age in mid-40's | 43 assigned of whom 40 completed | DSM-III-R MDD in full remission | Outpatient research clinic at university medical center | Single research psychiatrist | Prior exposure to CBT reduced residual symptoms relative to clinical management following medication withdrawal |
| Murphy et al 1995[68] | Cognitive behavior therapy (CBT) vs relaxation training (RT) vs antidepressant medications (ADM) | 20 sessions over 16 weeks | None | Adults aged 18-60 | 37 assigned of whom 24 completed | Feighner criteria for MDD | Outpatient research clinic with patients recruited via advertisement | Graduate students in psychology, doctoral level psychologist and clinical social worker | CBT and RT both superior to ADM and did not differ from one another (it is not clear why ADM did so poorly in this study) |
| Blackburn & Moore 1997[83] | Cognitive therapy followed by cognitive therapy (CT/CT) vs antidepressant medication followed by antidepressant medications (ADM/ADM) vs antidepressant medications followed by cognitive therapy (ADM/CT) | 16 weekly sessions (acute)/27 monthly sessions over next 2 years (maintenance) | None | Adults aged 18-65 | 75 assigned of whom 67 completed | RDC MDD primary | Outpatient research clinic (UMC) with referrals from general practice | Experienced clinical psychologists | No differences between treatments during acute or maintenance treatment |
| Scott et al., 1997[86] | Cognitive behavior therapy plus treatment-as-usual (CBT/TAU) | 6 weekly 30-minute sessions | Treatment- as-usual (TAU) | Adults aged 18-65 | 48 assigned of whom 34 completed | DSM-III-R MDD | Primary care | Professional discipline not specified | Combined treatment with CBT better than TAU alone |
| Fava et al., 1998[101] | WBT added to ADM vs ADM alone in recovered patients with history of recurrence | 10 sessions in 20 weeks to 24 month naturalistic follow-up | Medication withdrawal during 24 month naturalistic follow-up | Adults with mean age in late 40's | 40 assigned of whom 40 completed | RDC major depressive disorder in full remission | Outpatient research clinic at university medical center | Single research psychiatrist | Prior exposure to WBT prevented recurrence following medication withdrawal |
| Bright et al 1999[80] | Cognitive behavior therapy (CBT) vs mutual support group therapy (MSG) | Weekly 90-minute sessions over 10 weeks | None | Adults aged 18-60 | 98 assigned of whom 68 completed | DSM-III-R MDD or dysthymia or depression NOS | Outpatient psychology department clinic | Professional therapists and para-professional therapists | No differences between the treatment conditions with some indications of advantage for professional therapists within CBT conditions |
| Jarrett et al 1999[75] | Cognitive therapy (CT) vs antidepressant medication (ADM) | 20 sessions over 10 weeks | Pill-placebo | Adults with mean age in late 30's | 108 assigned of whom 71 completed | DSM-III-R MDD (atypical subtype) | Outpatient research clinic at university medical center | Psychiatrist and doctoral level psychologists | CBT or ADM both superior to pill-placebo (acute) |
| Paykel et al 1999[102] | Cognitive therapy added to ongoing antidepressant medication (CT plus ADM) vs antidepressant medication (ADM) for residual depression | 16 sessions in 20 weeks (with 2 extra booster sessions) followed by 48 week follow-up phase during which ADM continued | None | Adults aged 21-65 | 158 patients of whom 127 completed | DSM-III-R MDD in partial remission with residual symptoms | Outpatient research clinic at two university medical centers | Professional discipline not specified but all experienced | Adding CBT enhanced the efficacy of ADM in terms of enhancing full remission and preventing subsequent relapse and recurrence |
| Paykel et al 2005[103] | Six year follow-up found that enduring effects persisted through the first three years of follow-up | ||||||||
| Keller et al 2000 (acute)[116] | Cognitive behavioral analytic system for psychotherapy (CBASP) vs antidepressant medication (ADM) vs combination (CBASP/ADM) | 16 sessions in 12 weeks (acute phase) | None | Adults aged 18-75 | 681 assigned of whom 519 completed | DSM-IV chronic major depressive disorder or current MDD superimposed on dysthymia | Outpatient research clinics at university medical centers | Psychiatrists, doctoral level psychologists, and MSW level social workers | Combined treatment better than either single modality which did not differ (acute) |
| Klein et al 2004 (recurrence)[118] | CBASP | 13 monthly sessions over 52 weeks of maintenance | Assessment only control | Adults mean age 45.1 ± 11.4 years | 82 assigned of whom 61 completed | Acute and crossover CBASP responders | Maintenance CBASP reduced rate of recurrence relative to assessment only | ||
| Teasdale et al 2000[109] | Mindfulness-based cognitive therapy (MBCT) superimposed on treatment-as-usual (TAU) | 8 weekly two hour sessions followed by 52 week naturalistic follow-up | Treatment-as-usual (TAU) | Adults aged 18-65 | 145 assigned of whom 132 completed | DSM-III-R MDD with history of recurrence in full remission or recovery | Outpatient research clinics | Doctoral level clinical psychologists | MBCT plus TAU better than TAU at preventing relapse and recurrence in recovered patients with 3 or more prior episodes |
| Jarrett et al 2001[119] | Continuation cognitive therapy (C-CT) (following 20 sessions of acute phase CT) | 10 sessions in 8 months (followed by 16 months of naturalistic follow-up) | Assessment only control (following 20 sessions of acute phase CT) | Adults aged 18-65 | 84 assigned of whom 76 completed | DSM-IV MDD recurrent in remission | Outpatient research clinic at university medical center | Professional discipline not specified but all experienced | C-CT better than assessment only control in reducing risk for relapse and recurrence in remitted patients |
| Thompson et al (2001)[124] | Cognitive behavior therapy (CBT) vs antidepressant medication (ADM) vs combined treatment (CBT/ADM) | 16-20 sessions over 12-16 weeks | None | Geriatric aged 60 and over | 102 assigned of whom 71 completed | RDC MDD as ascertained by SADS | Outpatient research clinic at VA hospital and university medical center | Clinical psychologists with at least 1-year experience treating geriatric patients | Combined treatment generally better than ADM alone (especially with more severely depressed patients) with CBT alone intermediate and closer to combined |
| Perlis et al 2002 (sequential)[107] | Cognitive therapy added to ongoing antidepressant medication (CT/ADM) vs antidepressant medication (ADM) | 12 weekly sessions followed by 7 biweekly sessions | None | Adults aged 18-65 | 132 assigned of whom 85 | DSM-III-R MDD in remission | Outpatient research clinic | Doctoral level clinical psychologists | Adding CBT to ADM no better than increasing ADM dose in reducing relapse or residual symptoms |
| Miranda et al 2003[90] | Cognitive behavior therapy (CBT) vs antidepressant medication (ADM) | 8 weekly sessions followed by 8 more if needed | Community referral (CR) | Adults mean age 29.3 ± 7.9 years | 267 | DSM-IV MDD in mostly low-income minority women | County clinics, research offices and patient homes | Experienced psychotherapists | Both CBT and ADM reduced depression more than CR |
| Miranda et al 2005[91] | 12- month follow-up | Both continued CBT and ADM superior to CR | |||||||
| Ma & Teasdale 2004[110] | Mindfulness-based cognitive therapy (MBCT) superimposed on treatment-as-usual (TAU) | 8 weekly two hour sessions followed by 52 week naturalistic follow-up | Treatment-as-usual (TAU) | Adults aged 18-65 | 75 assigned of whom 69 completed | DSM-III-R MDD with history of recurrence in full remission or recovery | Outpatient research clinic | Experienced cognitive therapists | MBCT plus TAU better than TAU alone at preventing relapse and recurrence in recovered patients with 3 or more prior episodes |
| Bockting et al 2005[104] | Cognitive behavior therapy (CBT) superimposed on treatment-as-usual (TAU) | 8 two-hour weekly sessions | Treatment-as-usual (TAU) | Adults with mean age in mid 40's | 187 assigned of whom 165 completed | DSM-IV MDD with at least 2 prior episodes | Recruited from psychiatric centers via advertisements | Psychologists (including first author) | CBT plus TAU better than TAU alone at preventing relapse and recurrence with larger effects for patients with more prior episodes |
| Cuijpers et al 2005[92] | Cognitive behavior therapy (CBT) | Mean of 10 sessions (SD 11) | Treatment-as-usual (TAU) | Adults aged 18-65 | 425 assigned of whom 288 completed | DSM-IV MDD | Outpatient mental health centers | Experienced therapists | No differences among less severe but CBT superior to TAU among more severe |
| DeRubeis et al 2005 (acute)[76] | Cognitive therapy (CT) vs antidepressant medication (ADM) | 24 sessions 16 weeks | Pill-placebo | Adults aged 18-65 | 240 assigned of whom 204 completed | DSM-IV MDD (severe) | Outpatient research clinics at university medical centers | Doctoral level psychologists and psychiatric nurse | CT or ADM superior to pill-placebo control |
| Hollon et al 2005 (relapse)[97] | Prior CT vs continuation ADM | Medication withdrawal onto pill-placebo | Prior CT as efficacious as continued ADM and better than placebo withdrawal at preventing relapse | ||||||
| Wright et al 2005[130] | Computer-assisted cognitive therapy (CaCT) vs cognitive therapy alone (CT) | 9 sessions in 8 weeks | Wait list (WL) | Adults aged 18-65 | 45 assigned of whom 40 completed | DSM-IV MDD | University-affiliated psychiatric center | Master's and doctoral-level clinicians | CaCT comparable to live CT and both better than WL in reducing depression with gains maintained across 6-month follow-up |
| Smit et al 2006[102] | Cognitive behavior therapy plus depression recurrence prevention (CBT/DRP) vs DRP alone | 10-12 weekly sessions CBT then 3 sessions DRP | Treatment-as-usual (TAU) | Adults aged 18-70 | 267 assigned of whom 240 completed | DSM-IV MDD (using CIDI) | Primary care (55 different practices) | Cognitive therapists (educational level and experience unspecified) | No differences between the conditions |
| Strauman et al (2006)[128] | Cognitive therapy (CT) vs self-system therapy (SST) | 20 sessions weekly for first 6 weeks and at least biweekly thereafter | None | Adults age unspecified | 45 assigned of whom 39 completed | DSM-IV MDD or dysthymia (except for six patients) | University-based research clinic | Doctoral-level clinical psychologists and predoctoral interns | No overall differences between the conditions but SST better than CT for patients who lacked promotion goals |
| Rohan et al (2007)[127] | Cognitive behavior therapy (CBT) vs light therapy (LT) vs combined CBT plus LT (CBT/LT) | 12 90-minute sessions twice weekly over six weeks | Wait list | Adults aged 18 and older | 61 assigned of whom 54 completed | DSM-IV MDD recurrent with seasonal pattern | University-based research clinic | Doctoral level psychologist with graduate student co-therapists | All three active treatments comparable and each superior to wait list control |
| Thase et al 2007[126] | Cognitive therapy alone (CT) or in combination with medication (COMB) vs medication switch or augmentation | 16 sessions over 12 weeks | None | Adults aged 18-75 | 304 assigned | DSM-IV MDD with nonresponse to medication treatment | Community mental health and university-based clinics and primary care settings | Doctoral level psychologists, psychiatrists, masters-level social workers and psychiatric nurses | CT did not differ from medication switch but medication augmentation faster than CT augmentation |
| Bagby et al 2008[82] | Cognitive behavior therapy (CBT) vs antidepressant medication (ADM) | 16-20 weekly sessions | None | Adults aged 18-70 | 275 assigned of whom 174 completed | DSM-IV MDD | University-affiliated outpatient clinic | Master's and doctoral-level clinicians | No differences on continuous measures but ADM beat CT on response rates and with neurotic patients |
| Conradi et al 2008[105] | Cognitive behavior therapy plus psychoeducation (CBT/PE) vs psychoeducation (PE) | 10-12 CBT sessions followed by 3 PE sessions | Treatment-as-usual (TAU) | Adults aged 18-70 | 208 assigned with attrition not reported | DSM-IV MDD (using CIDI) | Primary care clinics | No information provided | CBT plus PE but not PE alone superior to TAU among patients with four or more prior episodes |
| David et al 2008[71] | REBT vs CT vs ADM (continued at reduced dose during follow-up) | 20 sessions over 14 weeks with 6 month follow-up | None | Adults with mean age in mid-30's | 170 assigned of whom 151 completed | DSM-IV MDD | Outpatient research clinic in university medical center | Doctoral-level psychologists and psychiatrists | No differences were evident between the conditions at end of treatment; REBT held up better than ADM at 6 months |
| Sava et al 2009[72] | REBT and CT both more cost-effective than ADM | ||||||||
| Faramarzi et al 2008[78] | Cognitive behavior therapy (CBT) vs antidepressant medications (ADM) | 10 weekly two-hour group sessions | Assessment only control | Adult women with fertility problems | 124 assigned of whom 89 completed | DSM-III-R MDD | Outpatient research clinic in university medical center | Experienced clinical therapists | CBT superior to ADM which was in turn superior to assessment only control |
| Kuyken et al 2008[111] | MBCT plus medication taper vs antidepressant medication (ADM) | 8 weekly sessions with four boosters over 52 week naturalistic follow-up | None | Adults aged 18 and above | 123 assigned of whom 104 completed treatment and 96 completed follow-up | DSM-IV MDD in remission with history of 3 or more prior episodes | Primary care | Doctoral level psychologists and occupational therapists | MBCT more effective than ADM in reducing residual symptoms and improving quality of life; 75% of MBCT patients able to discontinue ADM |
| Laidlaw et al 2008[125] | Cognitive behavior therapy (CBT) | 8 sessions (on average) | Treatment-as-usual (TAU) | Geriatric aged 60 and over | 44 assigned of whom 40 completed | DSM-IV MDD | Primary care | Masters level clinical psychologists and one graduate psychologist | CBT superior to TAU with respect to categorical diagnoses (and some continuous measures after controlling for patient characteristics) |
| Manber et al 2008[121] | Cognitive behavior therapy plus antidepressant medication (CBT/ADM) vs sleep hygiene plus ADM | 5 weekly sessions followed by 2 biweekly sessions | None | Adults aged 18-75 | 30 assigned of whom 28 completed | DSM-IV MDD plus insomnia | Outpatient research clinic in university medical center | Two licensed clinical psychologists | CBT plus ADM superior to ADM plus sleep hygiene control in terms of rates of remission from both depression and insomnia |
| Dozois et al 2009[123] | Cognitive therapy plus antidepressant medication (CT/ADM) vs antidepressant medication alone (ADM) | 15 weekly sessions | None | Adults aged 18-65 | 48 assigned of whom 42 completed | DSM-IV MDD | Outpatient tertiary care clinic | Two licensed master's level therapists | Adding CT did little to enhance the effects of ADM but did improve cognitive structure |
| Freedland et al 2009[122] | Cognitive behavior therapy plus usual care (CBT/UC) vs supportive stress management plus usual care (SSM/UC) | 12-16 weekly sessions | Usual care (with approximately half of all participants receiving antidepressant medications) | Adults aged 21 and older | 123 assigned of whom 113 completed | DSM-IV MDD (66%) or minor depressive episode (34%) undergoing coronary bypass surgery in the last year | Outpatient research clinic in university medical center | Experienced doctoral level clinical or counseling psychologists or clinical social workers | CBT and SSM both superior to usual care with CBT having greater and more durable effects than SSM |
| Kocsis et al 2009 (acute)[120] | Cognitive behavioral analytic system for psychotherapy plus antidepressant medication ((CBASP/ADM) vs brief supportive psychotherapy plus antidepressant medication (BSP/ADM) | 16 sessions in 12 weeks | Flexible algorithm-driven individualized antidepressant medication (ADM) | Adults aged 18-75 | 491 assigned of whom 423 completed | DSM-IV chronic major depressive disorder or current MDD superimposed on dysthymia who did not respond to12 weeks of medication treatment | Outpatient research clinics at university medical centers | Psychiatrists, doctoral level psychologists, and MSW level social workers | Augmenting flexible algorithm medication treatment with CBASP (or BSP) no more efficacious than ADM alone |
| Serfaty et al 2009[88] | Cognitive behavioral therapy plus treatment as usual (CBT/TAU) vs talking control plus treatment as usual (TC/TAU) | Up to 12 individual sessions over 4 months | Treatment-as-usual (including medications for about half) (TAU) | Geriatric aged 65 and above | 204 assigned of whom 177 completed | DSM-IV MDD (88%) or minor depression (12%) | Primary care | Experienced cognitive behavioral therapists (degree not specified) | CBT superior to TC when each added to TAU |
| Wilkinson et al 2009[108] | Cognitive behavioral therapy plus antidepressant medication (CBT/ADM) | Up to 8 90-minute group sessions | Antidepressant medication (ADM) | Geriatric aged 60 and above | 45 assigned of whom 36 completed | ICD MDD within last year and remitted for at least 2 months on ADM | General practice and psychiatric clinics | Doctoral level psychologist with experience in CBT | CBT reduced rates of recurrence but differences not significant in small sample |
| Behavioral: | |||||||||
| Nezu 1986[132] | Problem-solving therapy (PST) vs nonspecific therapy | 8 weekly 120-minute group sessions | Wait-list | Adult | 32 assigned of whom 26 completed | RDC MDD | Outpatient research clinic in university mental health center | Pre-doctoral graduate students in psychology | PST superior to either nonspecific or wait-list control |
| Nezu & Perri 1989[133] | Problem-solving therapy (PST) vs abbreviated PST | 10 weekly 90-minute group sessions | Wait-list | Adults aged 18-65 | 43 assigned of whom 39 completed | RDC MDD | Outpatient research clinic in university mental health center | Pre-doctoral graduate students in psychology | PST superior to either abbreviated PST or wait-list control |
| O'Leary & Beach 1990[138] | Behavioral marital therapy (BMT) vs cognitive therapy (CT) | 16 weekly sessions | Wait list | Adults aged 28-59 | 45 assigned of whom 45 completed | DSM-III MDD or dysthymia | Research clinic (recruited volunteers) | Pre- and post-doctoral clinical psychologists | BMT comparable to CT in reducing depression and both better than wait list; BMT better than CT or wait list on reducing marital distress |
| Beach & O'Leary 1992[139] | |||||||||
| Jacobson et al 1991[140] | Behavioral marital therapy (BMT) vs cognitive therapy (CT) vs combined treatment (BMT+CT) | 20 sessions over 12 weeks | None | Adults with mean age in high 30's | 72 assigned of whom 60 completed | DSM-III MDD | Research clinic (referrals and recruited volunteers) | Pre- and post-doctoral clinical psychologists and social worker | CT better than BMT for depression, whereas BMT better than CT for marital distress |
| Jacobson et al 1993[141] | |||||||||
| No differences between the groups across 12 months | |||||||||
| Arean et al 1993[134] | Problem-solving therapy (PST) vs reminiscence therapy (RT) | 12 weekly group sessions | Wait-list | Geriatric aged 55 and above | 75 assigned of whom 59 completed | RDC MDD | Outpatient research clinic in university medical center | Graduate students in clinical psychology | PST superior to RT and each superior to wait list |
| Mynors-Wallis et al 1995[135] | Problem-solving therapy (PST) vs antidepressant medication (ADM) | 6 30-minute sessions over 12 weeks (1st 60-minutes) | Pill-placebo (PLA) | Adults aged 18-65 | 91 assigned of whom 82 completed | Diagnostic method not specified | Primary care clinic | Psychiatrist and general practitioners (including authors) | PST or ADM superior to PLA |
| Van den Hout et al 1995[131] | Self-control therapy plus treatment-as-usual (SCT/TAU) | 12 weekly 90-minute group sessions | Treatment-as-usual (TAU) | Adults aged 20-59 | 49 assigned (number completed not reported) | DSM-III-R MDD or dysthymia | Psychiatric day-treatment center | Professional discipline not specified | Adding SCT enhanced response to TAU alone |
| Emanuels-Zuurveen & Emelkamp 1996[142] | Behavioral marital therapy (BMT) vs cognitive behavior therapy (CBT) | 16 weekly sessions | None | Adults with mean age in the high 30's | 36 assigned of whom 27 completed | DSM-III-R MDD | Outpatient research clinic in academic psychology department | Graduate students in clinical psychology | No differences between the conditions on depression with BMT having a greater impact on relationship variables |
| Jacobson et al 1996[144] | Behavioral component of cognitive therapy (bCT) vs partial cognitive therapy (pCT) vs full cognitive therapy (CT) | 20 sessions in 12 weeks | None | Adult with mean age in late 30's | 150 assigned of whom 137 completed | DSM-III-R MDD | Outpatient university clinic | Doctoral level clinical psychologists | No differences between different components in terms of reduction of acute distress |
| Gortner et al 1999[145] | |||||||||
| Prior CT vs prior pCT vs prior bCT | No differences with respect to prevention of subsequent relapse | ||||||||
| Dowrick et al 2000[137] | Problem-solving therapy (PST) vs depression prevention course (DPC) | 6 sessions (PST) and 8 sessions (DPC) | Assessment only control | Adults aged 18-65 | 425 assigned of whom 317 completed | DSM-IV MDD or Adj Disorder | Community settings | Health care professionals | Both PST and DPC superior to assessment only control |
| Mynors-Wallis et al 2000[136] | Problem-solving therapy (PST) vs antidepressant medication (ADM) vs combined treatment (PST/ADM) | 6 30-minute sessions over 12 weeks (1st 60-minutes) | None | Adults aged 18-65 | 151 assigned of whom 116 completed | RDC MDD | Primary care clinic | General practice physicians and research practice nurses | Combined treatment no more efficacious than PST or ADM (professional discipline of therapists made no difference) |
| Hopko et al., 2003[147] | Behavior activation (BA) vs nonspecific supportive psychotherapy (nSP) | 3 20-minute session per week for two weeks | None | Adults with a mean age of 30 | 25 assigned of whom 25 completed | Major Depression (unstructured psychiatric interviews) | Inpatient psychiatric hospital | Master-level clinicians | BA superior to nSP |
| Dimidjian et al 2006 (acute)[81] | Behavioral activation (BA) vs cognitive therapy (CT) vs antidepressant medication (ADM) | 20 sessions in 16 weeks | Pill-placebo (PLA) | Adults aged 18-60 | 241 of whom 172 completed | DSM-IV MDD | Outpatient research clinic at university medical center | Doctoral level clinical psychologists and social worker (BA or CT) and research psychiatrists (ADM) | BA equals ADM and each better than CT or pill-placebo in reducing acute distress among more severe with no differences among less severe |
| Dobson et al 2008 (relapse)[98] | Prior BT or CT vs ADM continuation | Medication withdrawal onto pill-placebo | |||||||
| Prior BA equals prior CT or continued ADM with prior CT better than withdrawal onto pill-placebo in preventing relapse | |||||||||
| Bodenmann et al 2008[143] | Coping-oriented couples therapy (COCT) vs CBT vs IPT | 10 two-hour biweekly sessions (COCT) vs 20 weekly sessions | None | Adults aged 18 to 60 | 60 assigned of whom 57 completed | DSM-IV MDD (75%) and Dysthymia (25%) | Multisite trial with private practitioners in five Swiss cities | Experienced therapists | No differences between the groups with respect to depression or marital distress although COCT did produce greater change in partner's expressed emotion |
| Experiential-Humanistic: | |||||||||
| Beutler et al 1991[148] | Focused expressive psychotherapy (FEP) vs cognitive behavior therapy (CBT) | 20 weekly group sessions | Supportive self-directive control | Adults aged 22 to 76 | 63 of whom 42 completed | DSM-III MDD | Outpatient research clinic at university medical center | Experienced doctoral level psychologists | Modest main effects favored CBT but resistant patients did best in supportive self-directed control |
| Greenberg & Watson, 1998[149] | Process experiential therapy (PET) components added to client centered therapy (CCT) | 16-20 weekly sessions | None | Adults with a mean age of 40 | 34 of whom 33 completed | DSM-III-R MDD | Outpatient clinic in academic department | Psychiatrist, doctoral psychologists, and graduate students in psychology | No differences between the conditions on measures of depression but PET superior to CCT on measures of interpersonal problems and self-esteem |
| Watson et al 2003[150] | Process experiential therapy (PET) vs cognitive therapy (CT) | 16 sessions over 16 weeks | None | Adults with a mean age in the high 30's | 93 assigned of whom 66 completed | DSM-IV MDD | Outpatient clinic in academic department | Graduate students in counseling psychology and doctoral level psychologists | No differences between the conditions on measures of depression but PET superior to CT on self-reports of interpersonal problems |
| Castonguay et al 2004[153] | Integrative CT (with humanistic and interpersonal strategies) | 16 sessions over 12-15 weeks | Wait list | Adults aged 18-55 | 28 assigned of whom 22 completed | DSM-IV MDD | Outpatient research clinic in psychology department | Graduate students in psychology | ICT superior to wait list control |
| Goldman et al 2006[151] | Emotion-focused therapy (EFT) vs client-centered therapy (CCT) | 16-20 sessions over 16 weeks | None | Adults with mean age in late 30's | 83 assigned of whom 72 completed | DSM-III-R MDD | Outpatient clinic in academic department | EFT superior to CCT | |
| Ellison et al 2009[152] | Responders to EFT less likely to relapse over subsequent 18 months than CCT responders | ||||||||
| Constantino et al 2008[154] | Integrative CT (with humanistic and interpersonal strategies) vs CT alone | 16 sessions over 13-16 weeks | None | Adults aged 18-65 | 22 assigned of whom 19 completed | DSM-IV MDD | Outpatient research clinic in university medical center | Graduate students in psychology | ICT superior to CT |
| Marital and Family: | |||||||||
| Freidman 1975[155] | Dynamic marital therapy vs antidepressant medication (ADM) vs combined treatment | 12 weekly sessions | Pill-placebo | Adults aged 21-67 | 196 assigned of whom 168 completed | Primary diagnosis of depression | Outpatient research clinic | Professional discipline unspecified | ADM better at reducing depression and dynamic marital therapy better at reducing marital distress; combined treatment retained specific benefits of each |
| Clarkin et al 1990[156] | Family therapy plus milieu therapy with antidepressant medication | 6 family sessions in 36 days | Milieu therapy with antidepressant medication | Adults with mean age in mid-30's | 56 assigned of whom 50 completed | DSM-III MDD (n=30) or BD (n=26) | Inpatient research setting at university medical center | Social workers | Female bipolar patients benefited from addition of family therapy but not unipolar patients |