About 121 million people world-wide are believed to suffer from depression. This can be seen in disturbed appetite, sleep patterns and overall functioning as well as leading to low self-esteem and feelings of worthlessness and guilt. It can lead to suicide and is associated with 1 million deaths a year.

Drugs and psychotherapy are common treatments, but a group of Cochrane Researchers set out to see whether there was evidence that music therapy could deliver benefits.

Music therapy might help ease the symptoms of depression, though its effectiveness as a stand-alone intervention is not certain, according to a recent review of five small studies.

Four of the studies found reduced depression symptoms in participants receiving music therapy compared to those who did not. The fifth study did not find any difference.

The benefits of music appeared greatest when providers used theory-based therapeutic techniques rather than “winging it.”

“In the four studies where there was an impact, there was a very coherent theoretical framework, a very coherent explanation of what went on in the session and obvious reasons why the therapists were there,” said lead author Anna Maratos. “In the study that showed no effect, there didn’t seem to be any theoretical underpinning to the intervention. We have no idea why the therapist was there, really.”

Therapeutic interventions included listening to music in groups, body movement and painting to music, and improvised singing.

The review appears in the most recent issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

Maratos, head of profession for Arts Therapies at the Central and Northwest London NHS Foundation Trust, and colleagues looked for randomized controlled trials that compared music therapy with other, more traditional interventions for depression. They found a dearth of rigorous research.

Because there was little or no uniformity in study approaches, study populations or therapeutic techniques, the researchers did not pool the results for meta-analysis.

Maratos said that although the fifth study did not meet reviewers’ eligibility criteria, it was included because it was the only study with a certified professional coordinating the sessions.

The reviewers defined music therapy as an intervention designed to improve health status that included musical interaction between therapist and patient within a structured theoretical framework and in which outcomes were born of music, talk inspired by music or therapeutic relationships.

Each study author determined his or her own definition of standard care, on the other hand, which included pharmacological, routine hospital and cognitive therapeutic treatment.

Three studies focused on adults aged 60 and older; one study looked at adults between ages 21 and 65; and one focused on 14- and 15-year-old adolescents.

Although the studies did not show a definitive cause-and-effect relationship between music therapy and clinical improvement in depression, the authors found a positive correlation. They attributed the unevenness of the studies’ results to the varied uses of music by therapists in the studies and the relative weakness of some researchers’ methods.

The researchers found unusually high levels of participation and compliance among patients receiving the interventions.

Shara Sand, Psy.D., clinical assistant professor of psychology at Yeshiva University in New York City, agreed with researchers’ conclusion that meta-analysis was not possible in the review, but said that the evidence of music’s influence on mood makes the research question interesting.

“It does make me wonder: What is standardized treatment [in music therapy]? There’s really a whole avenue of research that should be done,” Sand said.

She adding that music therapy broadens the range of interventions available to people who might shy away from traditional approaches: “There’s often an isolation and alienation; a difficulty connecting and with relatedness” for people with depression, and the music therapy might offer a less threatening option.

Maratos said that her own status as a licensed music therapist spurred her interest in doing the review and added that music therapy is a state-sanctioned mental health treatment in the United Kingdom.

Journal reference: Maratos AS, et al. Music therapy for depression (Review). Cochrane Database of Systematic Reviews 2008, Issue 1.