Non-pharmacological treatment of depression: a systematic review and evidence map

Evid Based Med. 2016 Dec;21(6):214-221. doi: 10.1136/ebmed-2016-110522. Epub 2016 Nov 11.


Background: The comparative effectiveness of non-pharmacological treatments of depression remains unclear.

Methods: We conducted an overview of systematic reviews to identify randomised controlled trials (RCTs) that compared the efficacy and adverse effects of non-pharmacological treatments of depression. We searched multiple electronic databases through February 2016 without language restrictions. Pairs of reviewers determined eligibility, extracted data and assessed risk of bias. Meta-analyses were conducted when appropriate.

Result: We included 367 RCTs enrolling ∼20 000 patients treated with 11 treatments leading to 17 unique head-to-head comparisons. Cognitive behavioural therapy, naturopathic therapy, biological interventions and physical activity interventions reduced depression severity as measured using standardised scales. However, the relative efficacy among these non-pharmacological interventions was lacking. The effect of these interventions on clinical response and remission was unclear. Adverse events were lower than antidepressants.

Limitation: The quality of evidence was low to moderate due to inconsistency and unclear or high risk of bias, limiting our confidence in findings.

Conclusions: Non-pharmacological therapies of depression reduce depression symptoms and should be considered along with antidepressant therapy for the treatment of mild-to-severe depression. A shared decision-making approach is needed to choose between non-pharmacological therapies based on values, preferences, clinical and social context.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Antidepressive Agents
  • Cognitive Behavioral Therapy*
  • Depression / therapy*
  • Depressive Disorder, Major / therapy*
  • Humans
  • Psychotherapy
  • Randomized Controlled Trials as Topic*


  • Antidepressive Agents