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Open Access Highly Accessed Study protocol

Treatment of depressive disorders in primary care - protocol of a multiple treatment systematic review of randomized controlled trials

Klaus Linde1*, Isabelle Schumann1, Karin Meissner13, Susanne Jamil1, Levente Kriston2, Gerta Rücker4, Gerd Antes4 and Antonius Schneider1

Author Affiliations

1 Institute of General Practice, Technische Universität München, Orleansstr. 47, D-81667 München, Germany

2 University Medical Center Hamburg-Eppendorf, Department of Medical Psychology, Martinistr. 52, D-20246 Hamburg, Germany

3 Institute of Medical Psychology, Ludwig-Maximilians-University Munich, Goethestr. 31, D-80336 München, Germany

4 Department of Medical Biometry and Statistics, University Medical Center Freiburg, Stefan-Meier-Str. 26, D-79104 Freiburg, Germany

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BMC Family Practice 2011, 12:127  doi:10.1186/1471-2296-12-127

Published: 15 November 2011

Abstract

Background

Several systematic reviews have summarized the evidence for specific treatments of primary care patients suffering from depression. However, it is not possible to answer the question how the available treatment options compare with each other as review methods differ. We aim to systematically review and compare the available evidence for the effectiveness of pharmacological, psychological, and combined treatments for patients with depressive disorders in primary care.

Methods/Design

To be included, studies have to be randomized trials comparing antidepressant medication (tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), hypericum extracts, other agents) and/or psychological therapies (e.g. interpersonal psychotherapy, cognitive therapy, behavioural therapy, short dynamically-oriented psychotherapy) with another active therapy, placebo or sham intervention, routine care or no treatment in primary care patients in the acute phase of a depressive episode. Main outcome measure is response after completion of acute phase treatment. Eligible studies will be identified from available systematic reviews, from searches in electronic databases (Medline, Embase and Central), trial registers, and citation tracking. Two reviewers will independently extract study data and assess the risk of bias using the Cochrane Collaboration's corresponding tool. Meta-analyses (random effects model, inverse variance weighting) will be performed for direct comparisons of single interventions and for groups of similar interventions (e.g. SSRIs vs. tricyclics) and defined time-windows (up to 3 months and above). If possible, a global analysis of the relative effectiveness of treatments will be estimated from all available direct and indirect evidence that is present in a network of treatments and comparisons.

Discussion

Practitioners do not only want to know whether there is evidence that a specific treatment is more effective than placebo, but also how the treatment options compare to each other. Therefore, we believe that a multiple treatment systematic review of primary-care based randomized controlled trials on the most important therapies against depression is timely.