Non-Pharmacological Treatment of Depressive Disorders: A Review of Evidence-Based Treatment Options
J. Dirmaier, M. Steinmann, T. Krattenmacher, B. Watzke, D. Barghaan, U. Koch and H. Schulz
Affiliation: University Medical Center Hamburg-Eppendorf, Department of Medical Psychology, MartinistraBe 52, 20246 Hamburg; Germany.
Background: The primary goals of this paper are to describe the collection and evaluation of various nonpharmacological
treatment options for depressive disorders and to establish a basis for the development of a standard for
the treatment of patients with depressive disorders.
Method: To identify evidence-based treatment elements, a comprehensive investigation of national and international
guidelines was conducted. 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 in which 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 treatment elements with an adequate level of evidence were identified as follows: psychotherapeutic interventions,
marital/couples/family therapy and counseling, inclusion of family members, psycho-education, exercise, problem
solving therapy, guided self-help and behavioral activation treatments. Further evidence-based methods include diagnostic
treatment elements, participative decision-making, development of the therapeutic alliance, Cognitive Behavioral
Analysis System for Psychotherapy, computerized cognitive behavior therapy, psychopharmacological therapy, combined
psychopharmacological and psychotherapeutic therapy, electroconvulsive therapy, phototherapy, sleep deprivation, repetitive
trans-cranial magnetic stimulation (rTMS) and acupuncture.
Conclusion: In summary, using a hierarchical approach, it was possible to assign different levels of evidence to the various
treatment options for depression.
Keywords: Depression, evidence-based treatment, guidelines, literature review, non-pharmacological treatment options, psychotherapy
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