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 depressive symptoms (SMD = −0.85; 95% CI, −1.37 to −0.34; three RCTs; one CCT; n = 142) and clinician-rated symptoms (SMD = −0.98; 95% CI, −1.69 to −0.27; three RCTs; one CCT; n = 219; moderate evidence) in the short term (up to three months) when music therapy plus standard care was compared with standard care alone. Only one study evaluated effects of the intervention over a longer period of six months. Regarding secondary outcomes, low-quality evidence revealed that music therapy plus standard care resulted in decreased anxiety symptoms (SMD = −0.74; 95% CI, −1.40 to −0.08; two RCTs; one CCT; n = 195) and improved functioning (SMD = 0.51; 95% CI, 0.02 to 1; one RCT; n = 67). Evidence was not sufficient to determine differences between music therapy and standard care or between different types of music therapy for either primary or secondary outcomes. However, one available RCT showed no statistically significant differences in patient-reported depressive symptoms between active and receptive music therapy (SMD = −0.01; 95% CI, −1.33 to 1.30; n = 9).

The studies in the meta-analysis were quite different from one another. Depression was diagnosed using a variety of rating scales and criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th ed.,⁵ and outcomes were also reported using various rating scales. The music therapy interventions were heterogeneous in terms of duration and number of sessions, individual vs. group therapy, and type of therapy. Five of the studies recruited participants from mental health service locations, two studies involved geriatric patients, and two others involved high school students. Although only one study reported negative outcomes, it did not demonstrate a difference in adverse events between patients who received therapy and those who did not. There were no differences in the number of individuals who left the study early when comparing those who received standard care plus music therapy with those who received standard care alone (odds ratio = 0.49; 95% CI, 0.14 to 1.70; P = .26; five RCTs; one CCT; n = 293).

Current guidelines do not recommend routinely adding music therapy to standard treatment for depressive disorders. Further studies are needed to better characterize aspects of music therapy interventions and determine long-term effects on depression and related conditions. However, this Cochrane review provides low- to moderate-quality evidence that music therapy is a low-cost and low-risk intervention that may be worth adding to standard care for patients with depressive disorders.

The practice recommendations in this activity are available at http://www.cochrane.org/CD004517.