Comparative benefits and harms of second generation antidepressants and cognitive behavioral therapies in initial treatment of major depressive disorder: systematic review and meta-analysis

Abstract

Study queStionWhat are the benefits and harms of second generation antidepressants and cognitive behavioral therapies (CBTs) in the initial treatment of a current episode of major depressive disorder in adults? MethodSThis was a systematic review including qualitative assessment and meta-analyses using random and fixed effects models. Medline, Embase, the Cochrane Library, the Allied and Complementary Medicine Database, PsycINFO, and the Cumulative Index to Nursing and Allied Health Literature were searched from January1990 through January 2015. The 11 randomized controlled trials included compared a second generation antidepressant CBT. Ten trials compared antidepressant monotherapy with CBT alone; three compared antidepressant monotherapy with antidepressant plus CBT. SuMMary anSwer and liMitationSMeta-analyses found no statistically significant difference in effectiveness between second generation antidepressants and CBT for response (risk ratio 0.91, 0.77 to 1.07), remission (0.98, 0.73 to 1.32), or change in 17 item Hamilton Rating Scale for Depression score (weighted mean difference, −0.38, −2.87 to 2.10). Similarly, no significant differences were found in rates of overall study discontinuation (risk ratio 0.90, 0.49 to 1.65) or discontinuation attributable to lack of efficacy (0.40, 0.05 to 2.91). Although more patients treated with a second generation antidepressant than receiving CBT withdrew from studies because of adverse events, the difference was not statistically significant (risk ratio 3.29, 0.42 to 25.72). No conclusions could be drawn about other outcomes because of lack of evidence. Results should be interpreted cautiously given the low strength of evidence for most outcomes. The scope of this review was limited to trials that enrolled adult patients with major depressive disorder and compared a second generation antidepressant with CBT, and many of the included trials had methodological shortcomings that may limit confidence in some of the findings. what thiS Study addSSecond generation antidepressants and CBT have evidence bases of benefits and harms in major depressive disorder. Available evidence suggests no difference in treatment effects of second generation antidepressants and CBT, either alone or in combination, although small numbers may preclude detection of small but clinically meaningful differences.

Depression in primary care: part 2—management

“…Evidence suggests that CBT has efficacy over treatment as usual, particularly for the treatment of depression with comorbid physical conditions, but effectiveness over other psychological, or pharmacological, interventions for depression has not been established 464748. We also found good evidence to support the use of problem solving therapy, particularly in situational forms of depression (that is, those reactive to stressful social circumstances)49 and for interpersonal therapy in treatment of acute depression and in relapse prevention (table 1).…”

Treating seasonal affective disorder with cognitive behavioural therapy is comparable to light therapy

“…However, alternative non-drug treatment approaches are also needed. Cognitive behavioural therapy (CBT) is an established and effective treatment for depressive disorders 3. Limited research examining CBT adapted specifically for SAD (CBT-SAD) is available.…”

Cognitive behavioural therapy or antidepressants for acute depression?

“…5 They found no substantial differences in short term efficacy and tolerability between the treatments. This is generally consistent with findings from previous meta-analyses, although (uniquely) this one is confined to second generation antidepressants.…”