Twenty-three experimental and quasi-experimental studies (3,564 participants) were included.
Two of four RCTs that evaluated the effect of selective serotonin reuptake inhibitors (SSRI) found reduced depression with paroxetine (η²=0.6) and sertraline (d=0.36) compared to placebo over 12 weeks and two studies found no difference with sertraline (d=0.06) and citalopram (d=0.09) versus placebo. No differences in adverse events were found between treatment and control. Strength of evidence was classed as high.
One study showed an improvement in depression for patients who received an erythropoiesis stimulating agent (darbepoetin-alpha) compared to placebo in 41 anaemic patients receiving optimal medical care (d=1.4). Only two of seven studies that evaluated exercise interventions found a significant difference between intervention and control which favoured exercise. No serious adverse events due to exercise were reported across all studies.
Seven RCTs found no significant effect on depression of disease management programmes regardless of the components, timing, duration and country (all d<0.2; RR success rates 1.06 to 1.40). Three of the four studies that evaluated the effect of complementary and alternative medicine (CAM) found a significant effect on depression (d range from 0.4 to 1.6). The overall body of evidence was considered weak.
A single study used a multimodal approach that combined cognitive-behavioural therapy (CBT) with exercise to treat outpatients found a sustained reduction in depression (d=1.0) and those who received only CBT (d=0.4), exercise (d <0.1) or attention control did not.