A Systematic Review of Comparative Efficacy of Treatments and Controls for Depression

Abstract

BackgroundAlthough previous meta-analyses have examined effects of antidepressants, psychotherapy, and alternative therapies for depression, the efficacy of these treatments alone and in combination has not been systematically compared. We hypothesized that the differences between approved depression treatments and controls would be small.Methods and FindingsThe authors first reviewed data from Food and Drug Administration Summary Basis of Approval reports of 62 pivotal antidepressant trials consisting of data from 13,802 depressed patients. This was followed by a systematic review of data from 115 published trials evaluating efficacy of psychotherapies and alternative therapies for depression. The published depression trials consisted of 10,310 depressed patients. We assessed the percentage symptom reduction experienced by the patients based on treatment assignment. Overall, antidepressants led to greater symptom reduction compared to placebo among both unpublished FDA data and published trials (F = 38.5, df = 239, p<0.001). In the published trials we noted that the magnitude of symptom reduction with active depression treatments compared to controls was significantly larger when raters evaluating treatment effects were un-blinded compared to the trials with blinded raters (F = 2.17, df = 313, p<0.05). In the blinded trials, the combination of antidepressants and psychotherapy provided a slight advantage over antidepressants (p = 0.027) and psychotherapy (p = 0.022) alone. The magnitude of symptom reduction was greater with psychotherapies compared to placebo (p = 0.019), treatment-as-usual (p = 0.012) and waiting-list (p<0.001). Differences were not seen with psychotherapy compared to antidepressants, alternative therapies or active intervention controls.ConclusionsIn conclusion, the combination of psychotherapy and antidepressants for depression may provide a slight advantage whereas antidepressants alone and psychotherapy alone are not significantly different from alternative therapies or active intervention controls. These data suggest that type of treatment offered is less important than getting depressed patients involved in an active therapeutic program. Future research should consider whether certain patient profiles might justify a specific treatment modality.

Multiple Nicotinic Acetylcholine Receptor Subtypes in the Mouse Amygdala Regulate Affective Behaviors and Response to Social Stress

“…Although there are available treatments, there is still a large proportion of patients that do not respond satisfactorily to traditional antidepressant therapies (Khan et al, 2012). Many etiological factors could underlie depressive disorders, including alterations in monoaminergic function, but several studies have implicated dysregulation of the cholinergic system in depression in human subjects (Janowsky et al, 1972;Risch et al, 1981).…”

Persistent leisure-time physical activity in adulthood and use of antidepressants: A follow-up study among twins

“…According to WHO (2012) recommendations, the treatment options for moderate to severe depression consist of basic psychosocial support which is combined with either antidepressant medication or psychotherapy (WHO, 2012). A recent systematic review on the effect of different treatments for depression concluded that antidepressants or psychotherapy alone are not significantly different from alternative therapies, such as exercise, or active intervention controls (Khan et al, 2012).…”

The Say ‘Yes’ to Life (SYTL) Program: A Positive Psychology Group Intervention for Depression

“…Best practice guidelines recommend a stepped-care approach to the treatment of MDD, with less intense interventions preceding more intensive treatment (American Psychiatric Association, 2010;NICE, 2009). Within a stepped-care approach, it is recommended that when patients do not respond to brief interventions, antidepressant medication be combined with structured psychological interventions (notably CBT), since the combination of these two treatment modalities leads to a lower relapse rate than either alone (Khan et al, 2012). With these research findings in mind, the SYTL program was developed as a treatment that combines effective CBT practices, interventions grounded in positive psychology, and principles of effective group therapy.…”