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CBT, antidepressants comparable for initial treatment of MDD

Cognitive behavioral therapy and antidepressants had comparable efficacy and are both viable options for initial treatment of major depressive disorder, though evidence was limited regarding other treatment options.

“Most patients receiving care for depression obtain treatment in primary care settings where second-generation antidepressants are the most commonly prescribed agents,” Gerald Gartlehner, MD, MPH, of Danube University, Krems, Austria, and colleagues wrote. “Despite the dominance of second-generation antidepressants, primary care patients and clinicians may want to consider other options for treating [major depressive disorder (MDD)]. These include psychological interventions, complementary and alternative medicine (CAM) options, exercise, or a combination of these treatments. Several systematic reviews indicate that such treatments are efficacious for MDD compared with placebo or other inactive interventions.”

To compare benefits and harms of second-generation antidepressants, psychological, complementary and alternative medicine and exercise treatments as first- and second-step interventions for adults with MDD, researchers conducted a systematic review and meta-analysis. The final analysis included 45 trials.

Researchers found moderate-strength evidence that cognitive behavioral therapy (CBT) and antidepressants had similar response (RR = 0.9; 95% CI, 0.76-1.07) and remission rates (RR = 0.98; 95% CI, 0.73-1.32).

Risk for adverse events was higher in trials for antidepressants compared with most other treatment options. However, data from nonrandomized studies was not available.

“Given comparable efficacy, CBT and antidepressants are both viable choices for initial MDD treatment. Treatment should be chosen after discussion with patients about the advantages and disadvantages of each option, including risks for particular adverse effects, potential drug interactions, and patient preferences (for example, regarding costs, patient beliefs, availability of treatment). The available evidence does not provide definitive answers about the comparative benefits and harms of other treatment options and antidepressants as first-step treatments,” the researchers wrote.

However, regarding second-step therapies, evidence supports switching to another antidepressant, cognitive therapy, or supplementing with a particular medication or cognitive therapy, according to researchers. – by Amanda Oldt

Disclosure: Gartlehner reports a contract with the Agency for Healthcare Research and Quality during the conduct of the study. Please see the full study for a list of all authors’ relevant financial disclosures.