To ascertain whether psychotherapies combined with medication are more efficacious than those without medication and determine which combinations yield the best results.

We conducted a network meta-analysis of randomised controlled trials (RCTs) comparing behavioural activation (BA), psychoanalytic/psychodynamic psychotherapy (DYN), interpersonal psychotherapy (IPT), individual face-to-face cognitive behavioural therapy (CBT (ftf)), group cognitive behavioural therapy (gCBT), and computerised or internet cognitive behavioural therapy (iCBT) with each other, or with treatment-as-usual (TAU) and wait list control (WLC) among adults formally diagnosed with depression. The psychotherapy arms were categorised as either psychotherapy alone or psychotherapy combined with medication (+ p). Treatment efficacy was assessed based on depression severity. We used a random-effects model to conduct a pairwise meta-analysis.

A total of 100 RCTs with 9,873 participants were included. The most common treatment was CBT (ftf) alone. All treatment arms were compared with TAU. Most psychotherapies combined with medication were superior to psychotherapy alone. In the subgroup analyses according to the baseline severity of depression, most psychotherapies combined with medication were more effective than psychotherapy alone in moderate-to-severe depression, whereas in mild depression, such differences were not observed. Among psychotherapies with medication, gCBT + p was significantly more effective than TAU and other psychotherapies in both the main and subgroup analyses.

The efficacy of depression treatment varied depending on the severity of the depressive condition. Notably, gCBT + p was identified as the most effective approach for treating adult depression.

Maintaining remission after electroconvulsive therapy (ECT) is of clinical relevance in patients with depression, and maintenance ECT is introduced in patients who fail to maintain remission after ECT. However, the clinical characteristics and the biological background of patients who receive maintenance ECT are barely understood.

At Keio University Hospital, Patients with major depressive disorder according to DSM-IV who received ECT between January 2012 and March 2019 followed by maintenance ECT (mECT group) and those who did not (aECT group) were included. Clinical characteristics including the results of neuroimaging marker for Parkinson’s disease and dementia with Lewy bodies were compared between groups.

Thirteen and one hundred forty-six patients were included in mECT and aECT groups, respectively. Compared with aECT group, the age of onset and the age of the first ECT was older in mECT group. Besides, mECT group showed significantly higher prevalence of melancholic feature (92.3% vs. 27.4%, p<0.001) and catatonic feature (46.2% vs. 9.6%, p=0.002). The results of neuroimaging marker obtained in 123I-metaiodobenzylguanidine scintigraphy and dopamine transporter scan revealed that 5 of 13 patients and 16 of 146 patients showed Parkinson’s disease and dementia with Lewy bodies in mECT and aECT groups, respectively.

Patients who underwent acute and maintenance ECT have impaired dopamine function. Investigating the neurobiology of patients who receiving maintenance ECT is an important area for development of appropriate treatment for depression.

Electroconvulsive therapy (ECT) is the most effective antidepressant treatment for severe depression. Although recent structural magnetic resonance imaging (MRI) studies have consistently reported ECT-induced hippocampal volume increases, most studies did not find the association of the hippocampal volume changes with clinical improvement. To understand the underlying mechanisms of ECT action, we aimed to identify the longitudinal effects of ECT on hippocampal functional connectivity (FC) and their associations with clinical improvement.

Resting-state functional MRI was acquired before and after bilateral ECT in 27 depressed individuals. A priori hippocampal seed-based FC analysis and a data-driven multivoxel pattern analysis (MVPA) were conducted to investigate FC changes associated with clinical improvement. The statistical threshold was set at cluster-level false discovery rate-corrected p < 0.05.

Depressive symptom improvement after ECT was positively associated with the change in the right hippocampus-ventromedial prefrontal cortex FC, and negatively associated with the right hippocampus-superior frontal gyrus FC. MVPA confirmed the results of hippocampal seed-based analyses and identified the following additional clusters associated with clinical improvement following ECT: the thalamus, the sensorimotor cortex, and the precuneus.

ECT-induced change in the right frontotemporal connectivity and thalamocortical connectivity, and changes in the nodes of the default mode network were associated with clinical improvement. Modulation of these networks may explain the underlying mechanisms by which ECT exert its potent and rapid antidepressant effect.