Second-generation antidepressants and cognitive-behavioral therapy (CBT) provide similar levels of effectiveness for treating major depressive order, an analysis of studies published over a 25-year period showed.
The findings, published as part of the Comparative Effectiveness Review No. 161 by the Agency for Healthcare Research and Quality (AHRQ), confirm a recent meta-analysis published in the BMJ (doi: 10.1136/bmj.h6019). That meta-analysis also found no significant differences in effectiveness between second-generation antidepressants (SGAs) and CBT in depression treatment.
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In the AHRQ report, 44 studies met the researchers’ criteria for analysis, which included showing how the benefits and harms of SGAs compared with the benefits and harms of psychological, complementary and alternative medicine, and exercise options as first-step interventions for adults with acute-phase major depressive order. The studies were published from Jan. 1, 1990 through Jan. 13, 2015, and the researchers rated the strength of the evidence on SGAs and CBT as “moderate.”
The researchers also searched for studies showing the effects of second interventions for depression that proved refractory but noted an absence of these studies.
For most comparisons of the studies’ outcomes for patients using different treatment options, no statistically significant differences were found between the benefits provided by SGAs and the other treatment options.
Adverse events were more likely to occur in patients who took medications than in those who were treated with CBT. Also, those on the antidepressants had a higher risk of experiencing adverse events or discontinuing treatment because of adverse events, compared with patients treated with CBT, acupuncture, or St. John’s wort, specifically.
“Given comparable benefits among treatments options, the choice of the initial treatment of [major depression] should consider results of previous treatments, patient preferences, and feasibility [such as costs, likely adherence, and availability], following a discussion of the advantages and disadvantages of each treatment option, including risks of particular adverse effects and potential drug interactions,” wrote Dr. Gerald Gartlehner and his colleagues.
Further study on this topic “should assess the remission, response to treatment, quality of life, functional capacity, suicidal ideas and behaviors, and adverse events using standardized measures to allow for more direct comparisons across studies using the same or similar SGAs and psychological interventions,” the researchers said.
Read the full report on the AHRQ website.