Psychological treatment of depression in older adults: A network meta-analysis.

OBJECTIVES

Several psychological treatments for depression in older adults have been found to be effective compared to control conditions. It is less clear, however, if these treatments have comparable effects. We aimed to examine the relative effects of these treatments.

DESIGN

Systematic review and network meta-analysis.

SETTING

Any outpatient setting.

PARTICIPANTS, INTERVENTIONS, MEASUREMENTS: We included randomized controlled trials examining the effects of psychological treatments in older adults with depression, and comparing a treatment with another treatment or a control condition (care-as-usual and waitlist). Only treatments with at least five trials were included.

RESULTS

We included 86 randomized trials (10,165 participants) examining five types of treatment: cognitive behavior therapy (CBT), behavioral activation therapy (BAT), problem-solving therapy (PST), supportive therapy (SUP) and life review therapy (LRT). The network was relatively well connected. CBT, BAT, PST and LRT were more effective than CAU (SMD range: 0.52-0.99) and WL (SMD range: (0.62-1.10). SUP was not more effective than WL or CAU. All therapies were more effective than SUP (SMD range: 0.43-0.80), except for BAT. LRT was more effective than CBT and BAT. However, we found a significant difference between direct and indirect evidence. After excluding outliers, the general conclusions were similar, except that LRT was no longer superior to other therapies.

CONCLUSIONS

CBT, LRT, BAT and PST are effective interventions in the treatment of depression in older adults, and they probably have comparable effects. LRT and CBT have lower drop-out and may be preferrable as first treatment.