Published randomised controlled trials (RCTs) were eligible where they compared psychological interventions with usual GP care or antidepressant drug treatment in patients diagnosed with major depression according to specified classification systems. Participants had to be recruited and psychological treatments delivered in primary care settings. Psychological interventions were required to defined criteria. Psychological interventions delivered in combination with other treatments were ineligible.
Included RCTs were conducted in UK, Australia and USA. The population was largely composed of women (83%). Mean age was 35.5 years (range 18 to 79 years). Psychological interventions included cognitive behaviour therapy (CBT), counselling, stress management, psychodynamic therapy, problem-solving therapy and interpersonal therapy. Interventions were usually carried out as individual sessions. Sessions lasted between 15 and 90 minutes and took place weekly for six to 16 weeks (median six). In most trials the psychological intervention was provided by health professionals who were not GPs. Antidepressants prescribed were nortriptyline, amitriptyline, fluvoxamine or paroxetine (where reported). Usual GP care included medication, counselling and referral to specialists; where medication was used this ranged from 49% to 96% by trial (where reported). Outcomes were not prespecified, but all except one study reported the Hamilton Depression Rating Scale and/or the Beck Depression Inventory.
The authors reported neither how the papers were selected for this review nor how many reviewers performed study selection.