Music Therapy for Depression

Donna Cohen; Elizabeth Maxwell

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Mar 1, 2020 Issue

Cochrane for Clinicians

Putting Evidence into Practice

Music Therapy for Depression

DONNA COHEN, MD, and ELIZABETH MAXWELL, MD, Family and Community Residency Program, Lancaster, Pennsylvania

Am Fam Physician. 2020 Mar 1;101(5):273-274.

Author disclosure: No relevant financial affiliations.

Clinical Question

Is music therapy an effective treatment for depression? Are there differences between the various types of music therapy?

Evidence-Based Answer

Moderate-quality evidence shows that music therapy added to standard care is more effective in the first three months than standard care alone for depressive symptoms based on clinician-rated outcomes (standardized mean difference [SMD] = −0.98; 95% CI, −1.69 to −0.27) and patient-reported outcomes (SMD = −0.85; 95% CI, −1.37 to −0.34; three randomized controlled trials [RCTs]; one controlled clinical trial [CCT]; n = 142). There is insufficient evidence to compare active and/or receptive music therapy techniques.1 (Strength of Recommendation: B, based on inconsistent or limited-quality patient-oriented evidence.)

Practice Pointers

Depression is a common problem marked by mood changes and loss of interest and pleasure in normal activities. In 2017, an estimated 17.3 million adults (7.1% of all adults) in the United States had at least one major depressive episode.2 Depression affects more than 300 million people worldwide and is projected to become a leading cause of disability by 2020.3 This update of the 2008 systematic review examines more recent, robust evidence to determine if music therapy is an effective treatment for depression and if the effectiveness varies by music type (i.e., active vs. receptive). Music affects a patient's emotional state by increasing dopaminergic activity, downregulating the hypothalamic-pituitary-adrenal axis, and stimulating the parasympathetic nervous system.4 Active music therapy involves the participant singing or playing an instrument, whereas receptive therapy involves passively listening to music. Both treatments use trained music therapists and may include self-reflection time. Either can be done alone or in a group setting.

This Cochrane review included eight RCTs and one CCT with a total of 421 participants.1 Data from 411 patients were included in the meta-analysis, which demonstrated an improvement in patient-reported dep

Author disclosure: No relevant financial affiliations.

References

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1. Aalbers S, Fusar-Poli L, Freeman RE, et al. Music therapy for depression. Cochrane Database Syst Rev. 2017;(11):CD004517....

2. National Institute of Mental Health. Major depression. Accessed July 30, 2019. https://www.nimh.nih.gov/health/statistics/major-depression.shtml

3. World Health Organization. Depression. Updated December 4, 2019. Accessed July 30, 2019. http://www.who.int/mediacentre/factsheets/fs369/en/

4. Ribeiro MKA, Alcântara-Silva TRM, Oliveira JCM, et al. Music therapy intervention in cardiac autonomic modulation, anxiety, and depression in mothers of preterms: randomized controlled trial. BMC Psychol. 2018;6(1):57.

5. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. American Psychiatric Association; 2017.

This series is coordinated by Corey D. Fogleman, MD, assistant medical editor.

A collection of Cochrane for Clinicians published in AFP is available at https://www.aafp.org/afp/cochrane.

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