Objective To assess the comparative effectiveness of exercise, antidepressants and their combination for alleviating depressive symptoms in adults with non-severe depression. Design Systematic review and network meta-analysis. Data sources Embase, MEDLINE, PsycINFO, Cochrane Library, Web of Science, Scopus and SportDiscus. Eligibility criteria Randomised controlled trials (1990–present) that examined the effectiveness of an exercise, antidepressant or combination intervention against either treatment alone or a control/placebo condition in adults with non-severe depression. Study selection and analysis Risk of bias, indirectness and the overall confidence in the network were assessed by two independent investigators. A frequentist network meta-analysis was performed to examine postintervention differences in depressive symptom severity between groups. Intervention drop-out was assessed as a measure of treatment acceptability. Results Twenty-one randomised controlled trials (n=2551) with 25 comparisons were included in the network. There were no differences in treatment effectiveness among the three main interventions (exercise vs antidepressants: standardised mean differences, SMD, −0.12; 95% CI −0.33 to 0.10, combination versus exercise: SMD, 0.00; 95% CI −0.33 to 0.33, combination vs antidepressants: SMD, −0.12; 95% CI −0.40 to 0.16), although all treatments were more beneficial than controls. Exercise interventions had higher drop-out rates than antidepressant interventions (risk ratio 1.31; 95% CI 1.09 to 1.57). Heterogeneity in the network was moderate (τ2=0.03; I2=46%). Conclusions The results suggest no difference between exercise and pharmacological interventions in reducing depressive symptoms in adults with non-severe depression. These findings support the adoption of exercise as an alternative or adjuvant treatment for non-severe depression in adults. Systematic review registration PROSPERO CRD4202122656.

中文翻译：

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运动、抗抑郁药及其联合治疗非重度抑郁症的比较效果：随机对照试验的系统评价和网络荟萃分析

目的 评估运动、抗抑郁药及其联合治疗对缓解非重度抑郁症成人抑郁症状的比较效果。设计系统审查和网络荟萃分析。数据来源 Embase、MEDLINE、PsycINFO、Cochrane Library、Web of Science、Scopus 和 SportDiscus。资格标准 随机对照试验（1990 年至今）检查运动、抗抑郁药或联合干预对非重度抑郁症成人的单独治疗或对照/安慰剂条件的有效性。研究选择和分析 偏倚风险、间接性和对网络的总体信心由两名独立研究者进行评估。进行了常客网络荟萃分析以检查组间抑郁症状严重程度的干预后差异。干预退出被评估为治疗可接受性的量度。结果 网络中包含 21 项随机对照试验 (n=2551) 和 25 项比较。三种主要干预措施的治疗效果没有差异（运动与抗抑郁药：标准化平均差，SMD，-0.12；95% CI -0.33 至 0.10，联合与运动：SMD，0.00；95% CI -0.33 至 0.33，组合与抗抑郁药：SMD，-0.12；95% CI -0.40 至 0.16），尽管所有治疗都比对照组更有益。运动干预的退出率高于抗抑郁干预（风险比 1.31；95% CI 1.09 至 1.57）。网络中的异质性适中 (τ2=0.03; I2=46%)。结论 结果表明，运动和药物干预在减轻非重度抑郁症成人的抑郁症状方面没有差异。这些发现支持将运动作为成人非重度抑郁症的替代疗法或辅助疗法。系统评价注册 PROSPERO CRD4202122656。