Non-pharmacological treatment of depressive disorders: a review of evidence-based treatment options.

Background: In recent years, the importance of guidelines and standards has increased constantly. This paper describes the development of a standard for the non-pharmacological treatment of patients with depressive disorders. Aim: The primary goal of this paper is to describe the collection and evaluation regarding evidence for various non-pharmacological treatment options for depressive disorders to establish a basis for the current development of a standard for the treatment of patients with depressive disorders. Method: In order to identify evidence-based treatment elements, a comprehensive investigation of national and international guidelines was conducted first. The extracted guidelines were then assessed with regard to aspects of methodological quality and evidence-based treatment elements. In a further step, specific and systematic literature searches for residual treatment elements were conducted. For the corresponding literature search, a hierarchical approach was chosen: current guidelines were reviewed first and systematic reviews and meta-analyses second. Psychopharmacological treatments were excluded from the analysis, because this is covered by specific guidelines. Results: The following treatment elements with an adequate level of evidence were identified: psychotherapeutic interventions, marital/couples/family therapy and counselling, inclusion of family members, psycho education, exercise, problem solving therapy, guided self-help and behavioral activation treatments. Further evidence-based methods include diagnostical treatment elements, participative decision-making, development of the therapeutic alliance, Cognitive Behavioral Analysis System for Psychotherapy, computarized cognitive behavior therapy, psychopharmacological therapy, combined psychopharmacological and psychotherapeutic therapy, electroconvulsive therapy, phototherapy, sleep deprivation, repetitive transcranial magnetic stimulation (rTMS), acupuncture and St. John's wort. Conclusion: In summary, using a hierarchical approach, it was possible to assign different levels of evidence to the various treatment options for depression.
PMID: 22353197