Expanding and personalizing treatments for depression: a systematic review and meta-analysis of single-person trials

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In Germany, about eight out of every hundred people meet the criteria for depression every year. Depressive disorders often have serious consequences for those affected, their family, their social relationships, and their ability to work. Several treatments are available for depression (e.g., various medications and various forms of psychotherapy) that have been tested in large-scale studies according to high scientific standards with hundreds of people. However, two out of five people do not respond adequately to the treatment first offered. At the same time, based on the available results, it is hardly possible to predict who will respond to which of the available treatments. In addition, people with unusual or difficult-to-treat characteristics (for example, advanced age, concomitant diseases, unclear diagnosis) are often excluded from large-scale scientific studies, so it is unclear to what extent the treatments work for them. So-called "single-person trials" determine or compare the effect of treatments for individual persons. They can usefully complement traditional scientific studies. First, they facilitate the study of new treatments that have not been previously tested or that have been adopted from the care of other conditions. Second, they allow consideration of individuals who are usually excluded from large-scale studies. Third, they can be conducted under everyday conditions and provide scientific evidence of the effect of a treatment directly for the individual. The present study aims to perform a systematic review of the evidence from single-person trials on the treatment of depression. In doing so, evidence on the effect of new treatments, scientific evidence for groups of people previously neglected in studies, and information on the usefulness of single-person trials conducted under everyday conditions can be obtained.