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Meta-analysis shows no differences between second generation antidepressants, CBT for MDD

Results from a meta-analysis of randomized clinical trials indicated no differences in treatment effects of second-generation antidepressants and cognitive behavioral therapy, either alone or in combination.

“Some research suggests that patients might prefer treatment with psychotherapy over drugs. Reasons for preferring psychotherapy over drugs include concerns about side effects and perceived ‘addictiveness’ of drugs. In addition, women and ethnic minorities may be more likely to prefer psychotherapies over drugs,” Halle R. Amick, MSPH, of the University of North Carolina at Chapel Hill, and colleagues wrote. “Regardless of which treatment patients prefer, some evidence suggests that patients who receive their treatment of choice fare better than those whose treatment is incongruous with their preferences.”

To compare second-generation antidepressants with cognitive behavioral therapy (CBT) in initial treatment of major depressive disorder, researchers conducted a systematic review and meta-analysis of 24 randomized controlled trials published between 1990 and 2015. Eleven trials compared a second-generation antidepressant with CBT, 10 compared antidepressant monotherapy with CBT alone, and three compared antidepressant monotherapy with antidepressant plus CBT.

Analysis indicated no statistically significant differences in effectiveness between second-generation antidepressants and CBT for response (risk ratio = 0.91; 95% CI, 0.77-1.07), remission (RR = 0.98; 95% CI, 0.73-1.32) or change in 17-item Hamilton Rating Scale for Depression score (weighted mean difference = –0.38; 95% CI, –2.87 to 2.1).

There were no significant differences in rates of overall study discontinuation (RR = 0.9; 95% CI, 0.49-1.65) or discontinuation due to lack of efficacy (RR = 0.4; 95% CI, 0.05-2.91). However, more patients who received a second-generation antidepressant withdrew from studies due to adverse events, compared with patients who received CBT. This difference was not statistically significant.

“In clinical decision-making, providers should consider not only the efficacy of second-generation antidepressants and [CBT] interventions but also patients’ preferences about potential adverse events, the costs and availability of each treatment and expected treatment effects,” Amick and colleagues wrote. “Given that the benefits of second generation antidepressants and [CBT] do not seem to differ significantly in treating major depressive disorder and that primary care patients may have personal preferences for one first-line treatment over the other, both treatments should be made accessible, either alone or in combination, to primary care patients with major depressive disorder.” – by Amanda Oldt

Disclosure: The researchers report no relevant financial disclosures.