Systematic review of non-pharmacological non-psychological augmentation strategies for the treatment of unipolar depression: Synthesis without meta-analysis (SWiM)

This review aimed to identify which non-pharmacological non-psychological treatments are effective augmentation strategies in treating depression and which primary therapies they most effectively augment.MethodsPubMed, CENTRAL, and PsycINFO were searched for randomised-controlled trials for non-pharmacological non-psychological augmentation strategies in adults with unipolar depression. The results were synthesised qualitatively following the Synthesis Without Meta-analysis (SWiM) guidelines. Risk of bias was assessed using the JBI critical appraisal tool.Results3609 studies were screened against title and abstract and 3505 irrelevant studies were excluded. 104 studies were assessed for full-text eligibility. 31 studies were included for analysis. Included studies investigated augmentation with photobiomodulation, neurostimulation, exercise therapies, probiotics and acupuncture.ConclusionNon-pharmacological non-psychological augmentation strategies can be useful for patients with suboptimal response to standard treatment; however, more high-quality large RCTs are needed to investigate the effectiveness of these treatments in augmenting specific therapies. Due to their low cost and favourable safety profiles bright light therapies and exercise should be considered to augment standard treatment in adults with depression. There is lower levels of evidence for acupuncture and probiotics.