Hypnotherapy for major depressive disorder: a systematic review of randomized clinical trials

Abstract

ABSTRACTIntroduction:Major Depressive Disorder (MDD) is one of the most debilitating diseases worldwide and has seen a significant increase in diagnoses during the pandemic, demanding more and better therapeutic tools to manage the post-pandemic scenario.Objective:The aim of this systematic review is to provide a comprehensive analysis of the last 20 years of clinical research on Hypnotherapy (HT) to determine whether this intervention has evidence to support its recommendation for the treatment of MDD.Methods:This review included only randomized clinical trials (RCTs) involving adult populations diagnosed with MDD, regardless of the severity level (mild, moderate, or severe) according to any validated diagnostic criteria, compared to a control group (active treatment or none), with any follow-up duration and free access to the manuscript. The bibliographic survey was planned to be as sensitive as possible, conducted across seven distinct databases: MEDLINE (PubMed), Embase, CENTRAL, PsycINFO, Scopus, ScieELO, and Latin American and Caribbean Health Sciences Literature (LILACS). To identify potentially eligible studies in the grey literature, researchers also searched the U.S. National Library of Medicine (ClinicalTrials.gov). The risk of bias was assessed by two independent investigators using Cochrane’s revised tool (RoB 2), and the final judgment was made by consensus. To better analyze the included studies, the certainty of the evidence was evaluated through the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Due to the lack of comparable studies, it was not possible to perform a meta-analysis; therefore, the studies were graphically displayed in Descriptive Forest Plots.Results:There is very low-quality evidence suggesting that hypnosis-based interventions may reduce the severity of depression, which precludes the clinical recommendation of this intervention for patients in the real world, pending the production of better evidence of effectiveness and safety, although no evidence of significant adverse effects was found.Other:This review was pre-registered with PROSPERO and can be accessed using the registration number CRD42023409631.