Comparative benefits and harms of antidepressant, psychological, complementary, and exercise treatments for major depression: An evidence report for a clinical practice guideline from the American College of Physicians

Gerald Gartlehner, Bradley N. Gaynes, Halle R. Amick, Gary N. Asher, Laura C. Morgan, Emmanuel Coker-Schwimmer, Catherine Forneris, Erin Boland, Linda J. Lux, Susan Gaylord, Carla Bann, Christiane Barbara Pierl, Kathleen N. Lohr

Research output: Contribution to journalArticle

  • 32 Citations

Abstract

Background: Primary care patients and clinicians may prefer options other than second-generation antidepressants for the treatment of major depressive disorder (MDD). The comparative benefits and harms of antidepressants and alternative treatments are unclear. Purpose: To compare the benefits and harms of secondgeneration antidepressants and psychological, complementary and alternative medicine (CAM), and exercise treatments as firstand second-step interventions for adults with acute MDD. Data Sources: English-, German-, and Italian-language studies from multiple electronic databases (January 1990 to September 2015); trial registries and gray-literature databases were used to identify unpublished research. Study Selection: Two investigators independently selected comparative randomized trials of at least 6 weeks' duration on health outcomes of adult outpatients; nonrandomized studies were eligible for harms. Data Extraction: Reviewers abstracted data on study design, participants, interventions, and outcomes; rated the risk of bias; and graded the strength of evidence. A senior reviewer confirmed data and ratings. Data Synthesis: 45 trials met inclusion criteria. On the basis of moderate-strength evidence, cognitive behavioral therapy (CBT) and antidepressants led to similar response rates (relative risk [RR], 0.90 [95% CI, 0.76 to 1.07]) and remission rates (RR, 0.98 [CI, 0.73 to 1.32]). In trials, antidepressants had higher risks for adverse events than most other treatment options; no information from nonrandomized studies was available. The evidence was too limited to make firm conclusions about differences in the benefits and harms of antidepressants compared with other treatment options as first-step therapies for acute MDD. For second-step therapies, different switching and augmentation strategies provided similar symptom relief. Limitation: High dropout rates, dosing inequalities, small sample sizes, and poor assessment of adverse events limit confidence in the evidence. Conclusion: Given their similar efficacy, CBT and antidepressants are both viable choices for initial treatment of MDD.

LanguageEnglish (US)
Pages331-341
Number of pages11
JournalAnnals of internal medicine
Volume164
Issue number5
DOIs
StatePublished - Mar 1 2016

Fingerprint

Practice Guidelines
Antidepressive Agents
Exercise
Depression
Psychology
Physicians
Major Depressive Disorder
Cognitive Therapy
Therapeutics
Complementary Therapies
Databases
Information Storage and Retrieval
Sample Size
Registries
Primary Health Care
Outpatients
Language
Research Personnel
Health
Research

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Comparative benefits and harms of antidepressant, psychological, complementary, and exercise treatments for major depression : An evidence report for a clinical practice guideline from the American College of Physicians. / Gartlehner, Gerald; Gaynes, Bradley N.; Amick, Halle R.; Asher, Gary N.; Morgan, Laura C.; Coker-Schwimmer, Emmanuel; Forneris, Catherine; Boland, Erin; Lux, Linda J.; Gaylord, Susan; Bann, Carla; Pierl, Christiane Barbara; Lohr, Kathleen N.

In: Annals of internal medicine, Vol. 164, No. 5, 01.03.2016, p. 331-341.

Research output: Contribution to journalArticle

Gartlehner, Gerald ; Gaynes, Bradley N. ; Amick, Halle R. ; Asher, Gary N. ; Morgan, Laura C. ; Coker-Schwimmer, Emmanuel ; Forneris, Catherine ; Boland, Erin ; Lux, Linda J. ; Gaylord, Susan ; Bann, Carla ; Pierl, Christiane Barbara ; Lohr, Kathleen N. / Comparative benefits and harms of antidepressant, psychological, complementary, and exercise treatments for major depression : An evidence report for a clinical practice guideline from the American College of Physicians. In: Annals of internal medicine. 2016 ; Vol. 164, No. 5. pp. 331-341.
@article{bb3ff3be60cc4c4dbd6a35498f64d63a,
title = "Comparative benefits and harms of antidepressant, psychological, complementary, and exercise treatments for major depression: An evidence report for a clinical practice guideline from the American College of Physicians",
abstract = "Background: Primary care patients and clinicians may prefer options other than second-generation antidepressants for the treatment of major depressive disorder (MDD). The comparative benefits and harms of antidepressants and alternative treatments are unclear. Purpose: To compare the benefits and harms of secondgeneration antidepressants and psychological, complementary and alternative medicine (CAM), and exercise treatments as firstand second-step interventions for adults with acute MDD. Data Sources: English-, German-, and Italian-language studies from multiple electronic databases (January 1990 to September 2015); trial registries and gray-literature databases were used to identify unpublished research. Study Selection: Two investigators independently selected comparative randomized trials of at least 6 weeks' duration on health outcomes of adult outpatients; nonrandomized studies were eligible for harms. Data Extraction: Reviewers abstracted data on study design, participants, interventions, and outcomes; rated the risk of bias; and graded the strength of evidence. A senior reviewer confirmed data and ratings. Data Synthesis: 45 trials met inclusion criteria. On the basis of moderate-strength evidence, cognitive behavioral therapy (CBT) and antidepressants led to similar response rates (relative risk [RR], 0.90 [95{\%} CI, 0.76 to 1.07]) and remission rates (RR, 0.98 [CI, 0.73 to 1.32]). In trials, antidepressants had higher risks for adverse events than most other treatment options; no information from nonrandomized studies was available. The evidence was too limited to make firm conclusions about differences in the benefits and harms of antidepressants compared with other treatment options as first-step therapies for acute MDD. For second-step therapies, different switching and augmentation strategies provided similar symptom relief. Limitation: High dropout rates, dosing inequalities, small sample sizes, and poor assessment of adverse events limit confidence in the evidence. Conclusion: Given their similar efficacy, CBT and antidepressants are both viable choices for initial treatment of MDD.",
author = "Gerald Gartlehner and Gaynes, {Bradley N.} and Amick, {Halle R.} and Asher, {Gary N.} and Morgan, {Laura C.} and Emmanuel Coker-Schwimmer and Catherine Forneris and Erin Boland and Lux, {Linda J.} and Susan Gaylord and Carla Bann and Pierl, {Christiane Barbara} and Lohr, {Kathleen N.}",
year = "2016",
month = "3",
day = "1",
doi = "10.7326/M15-1813",
language = "English (US)",
volume = "164",
pages = "331--341",
journal = "Annals of Internal Medicine",
issn = "0003-4819",
publisher = "American College of Physicians",
number = "5",

}

TY - JOUR

T1 - Comparative benefits and harms of antidepressant, psychological, complementary, and exercise treatments for major depression

T2 - Annals of Internal Medicine

AU - Gartlehner, Gerald

AU - Gaynes, Bradley N.

AU - Amick, Halle R.

AU - Asher, Gary N.

AU - Morgan, Laura C.

AU - Coker-Schwimmer, Emmanuel

AU - Forneris, Catherine

AU - Boland, Erin

AU - Lux, Linda J.

AU - Gaylord, Susan

AU - Bann, Carla

AU - Pierl, Christiane Barbara

AU - Lohr, Kathleen N.

PY - 2016/3/1

Y1 - 2016/3/1

N2 - Background: Primary care patients and clinicians may prefer options other than second-generation antidepressants for the treatment of major depressive disorder (MDD). The comparative benefits and harms of antidepressants and alternative treatments are unclear. Purpose: To compare the benefits and harms of secondgeneration antidepressants and psychological, complementary and alternative medicine (CAM), and exercise treatments as firstand second-step interventions for adults with acute MDD. Data Sources: English-, German-, and Italian-language studies from multiple electronic databases (January 1990 to September 2015); trial registries and gray-literature databases were used to identify unpublished research. Study Selection: Two investigators independently selected comparative randomized trials of at least 6 weeks' duration on health outcomes of adult outpatients; nonrandomized studies were eligible for harms. Data Extraction: Reviewers abstracted data on study design, participants, interventions, and outcomes; rated the risk of bias; and graded the strength of evidence. A senior reviewer confirmed data and ratings. Data Synthesis: 45 trials met inclusion criteria. On the basis of moderate-strength evidence, cognitive behavioral therapy (CBT) and antidepressants led to similar response rates (relative risk [RR], 0.90 [95% CI, 0.76 to 1.07]) and remission rates (RR, 0.98 [CI, 0.73 to 1.32]). In trials, antidepressants had higher risks for adverse events than most other treatment options; no information from nonrandomized studies was available. The evidence was too limited to make firm conclusions about differences in the benefits and harms of antidepressants compared with other treatment options as first-step therapies for acute MDD. For second-step therapies, different switching and augmentation strategies provided similar symptom relief. Limitation: High dropout rates, dosing inequalities, small sample sizes, and poor assessment of adverse events limit confidence in the evidence. Conclusion: Given their similar efficacy, CBT and antidepressants are both viable choices for initial treatment of MDD.

AB - Background: Primary care patients and clinicians may prefer options other than second-generation antidepressants for the treatment of major depressive disorder (MDD). The comparative benefits and harms of antidepressants and alternative treatments are unclear. Purpose: To compare the benefits and harms of secondgeneration antidepressants and psychological, complementary and alternative medicine (CAM), and exercise treatments as firstand second-step interventions for adults with acute MDD. Data Sources: English-, German-, and Italian-language studies from multiple electronic databases (January 1990 to September 2015); trial registries and gray-literature databases were used to identify unpublished research. Study Selection: Two investigators independently selected comparative randomized trials of at least 6 weeks' duration on health outcomes of adult outpatients; nonrandomized studies were eligible for harms. Data Extraction: Reviewers abstracted data on study design, participants, interventions, and outcomes; rated the risk of bias; and graded the strength of evidence. A senior reviewer confirmed data and ratings. Data Synthesis: 45 trials met inclusion criteria. On the basis of moderate-strength evidence, cognitive behavioral therapy (CBT) and antidepressants led to similar response rates (relative risk [RR], 0.90 [95% CI, 0.76 to 1.07]) and remission rates (RR, 0.98 [CI, 0.73 to 1.32]). In trials, antidepressants had higher risks for adverse events than most other treatment options; no information from nonrandomized studies was available. The evidence was too limited to make firm conclusions about differences in the benefits and harms of antidepressants compared with other treatment options as first-step therapies for acute MDD. For second-step therapies, different switching and augmentation strategies provided similar symptom relief. Limitation: High dropout rates, dosing inequalities, small sample sizes, and poor assessment of adverse events limit confidence in the evidence. Conclusion: Given their similar efficacy, CBT and antidepressants are both viable choices for initial treatment of MDD.

UR - http://www.scopus.com/inward/record.url?scp=84959277463&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84959277463&partnerID=8YFLogxK

U2 - 10.7326/M15-1813

DO - 10.7326/M15-1813

M3 - Article

VL - 164

SP - 331

EP - 341

JO - Annals of Internal Medicine

JF - Annals of Internal Medicine

SN - 0003-4819

IS - 5

ER -