New clinical practice guidelines advise physicians that cognitive behavioral therapy (CBT) and second-generation antidepressants (SGAs), are equally effective treatments for major depressive disorder (MDD) in adults.
The American College of Physicians (ACP) recommendation appears in the Annals of Internal Medicine.
“Patients are frequently treated for depression by primary care physicians, who often initially prescribe SGAs,” said ACP President Wayne J. Riley, M.D., M.P.H., M.B.A., M.A.C.P.
“However, CBT is a reasonable approach for initial treatment and should be strongly considered as an alternative treatment to SGAs where available, and after discussing treatment effects, adverse effect profiles, costs, accessibility, and preferences with patients.”
Major depression is a medical condition causing sadness that interferes with daily life, not a normal reaction to life situations such as the death of a loved one or the loss of a job.
Symptoms associated with depression include lack of energy and loss of interest in things previously enjoyed.
The American College of Physicians developed the guideline to summarize and grade the evidence on the comparative effectiveness and safety of non-drug treatments and commonly used medications, alone or in combination for major adult depression.
SSRIs are antidepressants that generally have fewer side effects than older antidepressants. Common SSRIs are citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft). SNRIs are newer medications such as venlafaxine and duloxetine.
Researchers evaluated outcomes including response, remission, functional capacity, quality of life, reduction of suicidality or hospitalizations, and harms.
Researchers report that moderate-quality evidence showed that CBT and SGAs are similarly effective treatments for MDD and that discontinuation rates are similar for CBT and SGAs.
Moderate quality evidence means that the authors are confident in the research finding but acknowledge that further research may change the conclusions.
Low-quality evidence showed no difference in effectiveness or adverse effects between first line treatment using SGAs compared to non-drug treatments (complementary and alternative medicines, or exercise monotherapies or combination therapies).
Lower quality research means that the research is uncertain and future studies are likely to change the findings.
Researchers discovered adverse effects commonly associated with SGAs include constipation, diarrhea, dizziness, headache, insomnia, nausea, sexual adverse events, and drowsiness.
For second line treatment after treatment failure with SGAs, low-quality evidence showed that strategies to switch to or augment with another drug or non-drug therapy are similarly effective.
Low-quality evidence showed that St John’s wort may be as effective as SGAs for treating MDD, and moderate-quality evidence showed that St John’s wort was better tolerated than SGAs.
However, St. John’s wort is not currently regulated by the Food and Drug Administration in the U.S. Because no standard is in place regarding the contents and potency of the medication, patients in the U.S. may not be able to get quality-controlled St John’s wort or reliably obtain preparations with similar effectiveness as those used in the included studies.