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

Agency for Healthcare Research and Quality.

Second-generation antidepressants and cognitive–behavioural therapy are both viable choices for initial treatment of major depression

“…The same authors recently published a similar review3 using the same data, but reported slightly different results by using different approaches for random effects meta-analysis. While the current study used the DerSimonian and Laird models, the recent study applied the restricted maximum likelihood models.…”

Is the Comparison between Exercise and Pharmacologic Treatment of Depression in the Clinical Practice Guideline of the American College of Physicians Evidence-Based?

“…Probably more than for other health conditions, comparative benefits of exercise and pharmacologic treatments have been examined and discussed in relation to depression (e.g., Stubbs et al, 2015; Gartlehner et al, 2016). According to the WHO (World Health Organization), depression is the leading cause of disability worldwide (WHO, 2016 http://www.who.int/mediacentre/factsheets/fs369/en/).…”

“…However, many patients do not respond to antidepressant medications, or experience side effects (Gartlehner et al, 2016). In addition, increasing evidence indicated a large placebo response, making it more challenging for novel medications to demonstrate their effectiveness (Rutherford et al, 2012).…”

“…On the other hand, two systematic reviews comparing antidepressants to other therapies – including exercise – as a basis for clinical practice guidelines for depression, disregarded exercise in their recommendations. One concluded that “The American College of Physicians recommends that clinicians select between either cognitive behavioral therapy or second-generation antidepressants to treat patients with major depressive disorder…” (Qaseem et al, 2016, p. 355), and the other that “given comparable efficacy, cognitive behavioral therapy and antidepressants are both viable choices for initial MDD treatment” (Gartlehner et al, 2016, p. 338). The aim of this perspective is to analyze the available literature on the efficacy of exercise vs. antidepressants in the treatment of depression and to suggest a few explanations for this discrepancy.…”

M.S. Næss svarer:

“…Den avgjørende faktoren for behandlingseffekt er altså ikke hvorvidt medikamentet modifiserer eller endrer transmitterfunksjonen i hjernen, men om pasienten har troen på at behandlingen virker (4). Teorien om at positiv forventning øker effekten av antidepressiva støttes blant annet av en analyse på over 16 000 deprimerte pasienter (5).…”