Systematic evidence review finds cognitive behavioral therapy as effective as antidepressant medicines in treating depression

Depres­sion: Treat­ment Beyond Med­ica­tion (The Dana Foundation):

“Major depres­sive dis­or­der affects near­ly 7 per­cent of peo­ple in the US aged 18 and up, accord­ing to the Depres­sion and Bipo­lar Sup­port Alliance. Those who seek treat­ment will most like­ly be pre­scribed a sec­ond-gen­er­a­tion anti­de­pres­sant med­ica­tion such as a selec­tive sero­tonin reup­take inhibitor (SSRI), tri­cyclic anti­de­pres­sant (TCA), or a monoamine oxi­dase inhibitor (MAOI). Some recent stud­ies, though, sug­gest that these types of med­ica­tions are not quite as effec­tive as pre­vi­ous­ly believed…There are alter­na­tive treat­ments to anti­de­pres­sant med­ica­tion, and in Feb­ru­ary 2016, the Amer­i­can Col­lege of Physi­cians issued a new clin­i­cal prac­tice guide­line sug­gest­ing that one—cognitive behav­ioral ther­a­py (CBT)—is an equal­ly viable choice to treat adults with depression…“We’re learn­ing that what we call depres­sion today may actu­al­ly be 10, 12, maybe even 15 dif­fer­ent dis­eases,” he says. “So where we hope to go is to find bio­mark­ers so we can iden­ti­fy for groups of patients, or indi­vid­ual patients, for whom one treat­ment or anoth­er treat­ment is bet­ter. Some patients may actu­al­ly need more than one treat­ment to get bet­ter. It’s pos­si­ble. But we don’t know yet. We still have a lot of work to do. But until we do that work, it’s good that we have some dif­fer­ent options we can try.”

Study: Non­phar­ma­co­log­ic Ver­sus Phar­ma­co­log­ic Treat­ment of Adult Patients With Major Depres­sive Dis­or­der: A Clin­i­cal Prac­tice Guide­line From the Amer­i­can Col­lege of Physi­cians (Annals of Inter­nal Med­i­cine). From the abstract:

• Descrip­tion: The Amer­i­can Col­lege of Physi­cians (ACP) devel­oped this guide­line to present the evi­dence and pro­vide clin­i­cal rec­om­men­da­tions on the com­par­a­tive effec­tive­ness of treat­ment with sec­ond-gen­er­a­tion anti­de­pres­sants ver­sus non­phar­ma­co­log­ic treat­ments for major depres­sive dis­or­der in adults.
• Meth­ods: This guide­line is based on a sys­tem­at­ic review of pub­lished, Eng­lish-lan­guage, ran­dom­ized, con­trolled tri­als from 1990 through Sep­tem­ber 2015 iden­ti­fied using sev­er­al data­bas­es and through hand search­es of ref­er­ences of rel­e­vant stud­ies. Inter­ven­tions eval­u­at­ed include psy­chother­a­pies, com­ple­men­tary and alter­na­tive med­i­cines (includ­ing acupunc­ture, ?-3 fat­ty acids, S‑adeno­syl-l-methio­n­ine, St. John’s wort [Hyper­icum per­fo­ra­tum]), exer­cise, and sec­ond-gen­er­a­tion anti­de­pres­sants. Eval­u­at­ed out­comes includ­ed response, remis­sion, func­tion­al capac­i­ty, qual­i­ty of life, reduc­tion of sui­ci­dal­i­ty or hos­pi­tal­iza­tions, and harms…
• Rec­om­men­da­tion: ACP rec­om­mends that clin­i­cians select between either cog­ni­tive behav­ioral ther­a­py or sec­ond-gen­er­a­tion anti­de­pres­sants to treat patients with major depres­sive dis­or­der after dis­cussing treat­ment effects, adverse effect pro­files, cost, acces­si­bil­i­ty, and pref­er­ences with the patient (Grade: strong rec­om­men­da­tion, mod­er­ate-qual­i­ty evidence).
• Sum­ma­ry for patients Here…“The authors looked at research that com­pared dif­fer­ent treat­ment options for adults with MDD. The authors found that both talk ther­a­py and anti­de­pres­sant med­i­cines were equal­ly effec­tive in treat­ing MDD. St. John’s wort may be as effec­tive as anti­de­pres­sants and talk ther­a­py. How­ev­er, because St. John’s wort is not reg­u­lat­ed in the Unit­ed States, talk to your doc­tor before tak­ing it. Oth­er alter­na­tive treat­ments may not be as effec­tive as anti­de­pres­sant med­i­cines or talk therapy.”

To learn more:

• Should Cog­ni­tive Behav­iour­al Ther­a­py (not anti­de­pres­sant drugs) be the first-line treat­ment for depression?
• Ther­a­py or anti­de­pres­sants? Com­ing soon: Brain activ­i­ty “fin­ger­prints” to per­son­al­ize depres­sion treatments