De effectiviteit van psychotherapie in de eerste lijn bij patïnten met een depressieve stoornis een systematisch overzicht

BACKGROUND: Psychotherapy may be an alternative to drug treatment for depressive disorder in primary care. AIM: To give a systematic review about the effectiveness of psychotherapy for depressive disorder in primary care. METHOD: Randomised controlled trials were selected in which the effectiveness of psycho therapy was studied in primary care patients with depressive disorder, using Medline, Psychinfo, the Cochrane library and Embase. Effect differences were estimated according to the standardized mean difference. RESULTS: Ten studies met the selection criteria. Overall (based upon five studies), psychotherapy applied in a primary care setting was slightly more effective than usual care by a primary care physician for patients with depressive disorder. In seven studies psychotherapy was as effective as farmacotherapy for primary care patients with a depressive disorder. In one study, psychotherapy was more effective than placebo therapy for primary care patients with major depression. In patients with minor depression or dysthymia there was no difference between psychotherapy and placebo (two studies). CONCLUSION: Psychotherapy is a good alternative to drug treatment, also in primary care patients with depressive disorder. Further research is needed to show to what extent psychotherapy is a feasible option in primary care.