Review: relaxation better than wait-list, minimal or no treatment for depression but not as good as psychological treatments

Question:
Do relaxation techniques have an effect on depressive symptoms and outcomes compared with other treatment approaches?

Outcomes:
Symptoms of depression on a validated, reliable, self-rated and clinician rated depression symptoms scale (see online notes).

METHODS
Design:
Systematic review with meta-analysis.

Data sources:
Cochrane Depression, Anxiety and Neurosis Group registers; search to February 2008.

Study selection and analysis:
Two reviewers independently selected and appraised randomised or quasi-randomised controlled trials (including crossover trials and cluster randomised trials). Inclusion criteria: patients of any age, primary diagnosis of depression (based on Feighner criteria, Research Diagnostic criteria, DSM-III or ICD 10 onwards, or depression symptoms), including those with depression comorbid to a secondary medical condition, studies comparing relaxation techniques (progressive muscle relaxation, relaxation imagery, autogenic training or combinations or enhancements of these) or adjunct relaxation therapies with control conditions (including wait-list, no treatment or minimal treatment, psychological treatment, lifestyle and complementary therapies or medication). Exclusion criteria: studies where the primary focus was anxiety disorder or symptoms. Two reviewers independently extracted data and reviewed study quality. Standardised mean differences in post-treatment symptom scores on both self-rated and clinician rated depression scores were used as a measure of effect size. Heterogeneity was assessed using the I2 statistic and sensitivity analyses performed where I2 was > 50%. Fixed effects meta-analyses were applied, except in cases of significant heterogeneity where a random …