Twenty four randomised controlled trials (RCTs) were included in the review (n=3,348 participants).
Methodological quality:
In six pharmacological RCTs, sample size was reported as adequate in two trials, method of randomisation was adequately described in all trials, method of allocation concealment was adequately described in three trials, blinding was reported in all trials. In addition, all RCTs clearly reported interventions, had a representative group of participants, and provided the number and reasons for withdrawals.
In all 18 psychotherapeutic RCTs, subjects were randomly allocated to treatment groups, and method of randomisation was adequately described in all trials, method of allocation concealment was adequately reported in six trials, blinding of investigators was only reported in two trials. All RCTs provided a clear description of intervention and had a representative source of subjects. Sixteen RCTs reported attrition rates, with reasons for withdrawal being reported in 13 trials. All RCTs clearly described and used reliable outcome measures.
Pharmacological studies:
Paroxetine: Three RCTs (n=683 participants) reported that paroxetine was significantly more effective than placebo in reducing depression and depressive symptoms. Only one trial reported on tolerability; three of 20 participants in the paroxetine group experienced retinal haemorrhage.
Fluoxetine: Two RCTs (n=254 participants) compared fluoxetine with placebo; one trial reported a significant improvement in depression, and the other did not. In one of the RCTs there was a significantly higher frequency of vomiting in the treatment group compared to the placebo group. The other study did not observe any differences in side effects between the groups.
Mianserin: One RCT (n=55 participants) found a reduction in depressive symptoms in breast cancer patients receiving mianserin compared with placebo (p=0.004). No significant differences between groups were reported for tolerability.
Psychotherapeutic studies:
Depression: One RCT (n=200 participants) reported significant improvements in depression for counseling/psychotherapy compared to control group. One RCT (n=53) reported that counselling and relaxation therapy significantly improved depression compared to control group. One RCT (n=450) reported that computer based assessments and individually tailored care plans were associated with a reduction in the proportion of moderately or severely depressed cancer patients compared to control. However, one RCT (n=53) found no significant effects of cognitive behavioural therapy together with problem solving therapy.
Cognitive behavioural therapy: Seven RCTs (n=959 participants) reported a significant reduction in depressive symptoms for cognitive behavioural therapy compared to placebo. However, two RCTs (n=103) found no significant differences on depressive symptoms. One RCT (n=36) reported a significant reduction in depressive symptoms undergoing counselling and psychotherapy.
Counselling/psychotherapy: One RCT (n=53 participants) reported counselling and relaxation to be effective in reducing mild to moderate depressive symptoms but not for severe depressive symptoms 6 weeks after therapy.
Supportive: One RCT (n=79 participants) reported that the provision of group social support was found to be as effective as cognitive behavioural therapy in reducing depressive symptoms. Significant reductions in depressive symptoms were reported for other supportive interventions compared to control including: peer support (one RCT, n=46 participants); web based social support group (one RCT, n=72 participants); computer-based assessments and individually tailored care plans together with emotional support and counselling by nurses (one RCT, n=109 participants); computer-based assessments and individually tailored care plans (one RCT, n=450 participants). One RCT (n=11 participants) reported reductions in depressive symptoms after support from a breast care nurse alone, but not for other combined interventions.