The available evidence suggests no difference in the treatment effects of second generation antidepressants and cognitive behavioral therapy (CBT), either alone or in combination, for patients with severe depression, according to a new international study.
Because patients have personal preferences for one treatment over the other, both should be made accessible to patients with major depressive disorder, researchers advise.
Major depressive disorder is the most common and disabling form of depression, affecting more than 32 million Americans. Treatment is often started in a primary care setting, usually with second generation antidepressant drugs, such as SSRIs.
CBT is a type of psychotherapy that works to solve problems and change unhelpful thinking and behavior.
While some research has suggested that patients might prefer treatment with psychotherapy over medication, evidence about which treatments are most effective has been unclear, according to researchers.
That’s what compelled a team led by Gerald Gartlehner, M.D., M.P.H., at Danube University in Austria, to analyze the results of 11 randomized controlled trials.
Each trial compared second generation antidepressants and CBT for the initial treatment of major depressive disorder. The studies involved more than 1,500 patients.
The researchers, including Halle Amick, M.S.P.H., and colleagues at the University of North Carolina and the Research Triangle Institute International, noted they took differences in study design and quality into account to minimize bias.
They found no statistically significant difference in effectiveness between second generation antidepressants and CBT for response, remission, or change in depression score.
Additionally, no significant differences were found in rates of overall study discontinuation or discontinuation due to lack of effectiveness, according to the study’s findings.
No conclusions could be drawn about other outcomes because of lack of evidence, and the researchers stress their results “should be interpreted cautiously given the low strength of evidence for most outcomes.”
Nevertheless, they say their findings “are relatively consistent with similar meta-analyses.”
Additionally, they recommend in the study, which was published in the British Medical Journal (BMJ). that both treatments “should be made accessible, either alone or in combination, to primary care patients with major depressive disorder.”
In an accompanying editorial, psychiatrist Mark Sinyor, M.D., and colleagues at the University of Toronto say both options look equally effective, although evidence is limited.
They advocate for more, high quality research comparing antidepressants with CBT in acute depression.
In the meantime, they say policymakers “must acknowledge the World Health Organization’s projection that major depressive disorder will be the leading cause of disease burden worldwide by 2030 by taking more meaningful steps towards primary prevention.”
They believe these steps should include efforts “to correct social antecedents of major depressive disorder, such as poverty and lack of education, along with improved mental health curriculums in schools.”
Students could also be taught basic CBT or other interventions, such as mindfulness, “with the aim of preventing symptoms rather than relying on treatment once symptoms start,” the editorial concludes.
Source: British Medical Journal