MedicalResearch.com Interview with:
Halle Amick, research associate
Sheps Center for Health Services Research
University of North Carolina at Chapel Hill
Chapel Hill, NC
Medical Research: What is the background for this study? What are the main findings?
Response: Major depressive disorder (MDD) affects more than 32 million Americans and millions more worldwide. Many patients first seek care from a primary care provider, and the most common treatment initiated in that setting is medication. Although there is an evidence base that shows certain psychotherapies to be effective treatments, primary care providers may not be familiar enough with psychotherapy to present it as a treatment option. We conducted a full review of clinical trials that compared antidepressant medication—specifically second-generation antidepressants (SGAs)—with cognitive behavioral therapy (CBT).
We found that symptom improvement and rate of remission were similar between SGAs and CBT, whether they were used alone or in combination with each other. We also found no difference in the rates of withdrawal from the clinical trials either overall or due to adverse events.
Medical Research: What should clinicians and patients take away from your report?
Response: Clinicians should bring psychotherapy into the discussion of treatment options for MDD and to discuss the advantages and disadvantages of both treatments. Doing so may empower patients to participate fully in the shared decision-making process. Patients should consider cognitive behavioral therapy to be an effective treatment for Major depressive disorder and should discuss its pros and cons with their providers.
Medical Research: What recommendations do you have for future research as a result of this study?
Response: We found few studies that measured quality of life and functional capacity, both important patient-centered outcomes. We excluded some studies from some analyses because of significant methodological shortcomings; future trials should be conducted with suitable rigor. Finally, given that SGAs and CBT have similar efficacy, trials of interventions that teach primary care clinicians basic cognitive behavioral skills could help providers treat and perhaps prevent Major depressive disorder with a multifaceted approach.
Amick Halle R, Gartlehner Gerald, Gaynes Bradley N, Forneris Catherine, Asher Gary N, Morgan Laura C et al. Comparative benefits and harms of second generation antidepressants and cognitive behavioral therapies in initial treatment of major depressive disorder: systematic review and meta-analysis BMJ 2015; 351 :h6019
Halle Amick. (2015). Cognitive Therapy and Antidepressants Have Equivalent Outcomes in Major Depressive Disorder