Efficacy differences of acute-phase strategies for adult depression: A comprehensive network meta-analysis based on evidence from 2019 to 2024.

Depression, a condition severely endangering individual health and societal progress, is projected by the WHO to become the leading global disease burden by 2030. Currently, three categories of therapies are employed in clinical practice: psychotherapy, pharmacotherapy, and physical therapy. The treatment strategies utilized include monotherapy with each of the three modalities and combination therapy involving any two of them. However, the clinical efficacy of these treatment strategies remains unclear. Through a network meta-analysis, this study evaluated and compared the therapeutic effects of monotherapies and various combination therapies over the past five years. This study included 67 articles published between 2019 and 2024, totaling 7351 patients. The results demonstrated that, in the efficacy comparison of monotherapies, the three treatment modalities showed no significant differences in treatment response and remission rates during the acute phase of adult depression. In the efficacy comparison between combination therapies and monotherapies, we found that the combination of psychotherapy and pharmacotherapy significantly outperformed both corresponding monotherapies. Specifically, we found that the response rate for SSRIs/BZDs combined with CBT was significantly higher than that for CBT monotherapy or SSRIs/BZDs monotherapy. Through effect-size analysis, we further observed that this advantage is not merely an additive effect of the two treatment modalities, but rather a synergistic enhancement arising from their mutual synergy, which amplifies their respective therapeutic efficacy. Furthermore, we found no evidence that combining psychotherapy or pharmacotherapy with physical therapy conferred any significant advantage over monotherapy. This study provides supporting evidence and references for the clinical practice of combination therapy strategies.