Marital therapy has been suggested as a treatment for couples with a depressed spouse on the basis of the strong association between depressive symptoms and marital distress; the role played by marital negative factors on onset and maintenance of depressive disorders; and the possible buffering effect of interpersonal support and enhanced intimacy on depressive symptoms. Therefore, marital therapy has the two-fold aim of modifying negative interactional patterns and increasing mutually supportive aspects of couple relationships. This review aimed to provide an overall assessment of the role of marital therapy among psychological treatments for depression. The meta-analysis showed that there was no evidence to consider marital therapy as more or less effective than individual psychotherapy, either reducing depressive symptoms or the proportion of participants who remained depressed at caseness level (persistence of depression). The absence of a significant difference also held true when only distressed couples were included. However, in comparison to no/minimal treatment, the outcome for depressive symptoms and persistence of depression was better in the marital therapy group. There were no significant differences in the number of dropouts between the marital therapy group than in the individual psychotherapy group, this was also true when only distressed couples were analysed. Marital distress was significantly lower and persistence of marital distress significantly less frequent in the marital therapy group than in the individual treatment group. This effect was enhanced when distressed couples were considered separately. In comparison with drug therapy only data from two studies about dropout rates were available, showing significant relative risk in favour of marital therapy. All the results should be regarded in light of the methodological limitations of the studies, which, in general, are affected by small sample sizes; assessments at the end of treatment or short follow-up; unclear sample representation; and loss of patients at follow-up. The mediating role of other variables, such as improvement in marital satisfaction, could not be adequately tested. Although there is no evidence to consider marital therapy as more or less effective than individual psychotherapy or drug therapy for depression, the evidence for improvement in couple relationships due to marital therapy may favour the choice of marital therapy when marital distress is perceived as a major problem. Otherwise, the choice rests on patient preference and availability of specific resources.