AI Article Synopsis
- This study reviews over 140 treatment options for major depressive disorder (MDD) and assesses the reliability of the available evidence for patients and clinicians.
- The research gathered data from various systematic reviews, focusing on randomized controlled trials published between 2011 and 2017.
- Findings indicate that while second-generation antidepressants show strong efficacy, most non-pharmacological treatments lack sufficient evidence, with only cognitive behavioral therapy being moderately supported as an effective alternative.
Article Abstract
Objectives: This study aims to summarise the evidence on more than 140 pharmacological and non-pharmacological treatment options for major depressive disorder (MDD) and to evaluate the confidence that patients and clinicians can have in the underlying science about their effects.
Design: This is a review of systematic reviews.
Data Sources: This study used MEDLINE, Embase, Cochrane Library, PsycINFO and Epistemonikos from 2011 up to February 2017 for systematic reviews of randomised controlled trials in adult patients with acute-phase MDD.
Methods: We dually reviewed abstracts and full-text articles, rated the risk of bias of eligible systematic reviews and graded the strength of evidence.
Results: Nineteen systematic reviews provided data on 28 comparisons of interest. For general efficacy, only second-generation antidepressants were supported with high strength evidence, presenting small beneficial treatment effects (standardised mean difference: -0.35; 95% CI -0.31 to -0.38), and a statistically significantly higher rate of discontinuation because of adverse events than patients on placebo (relative risk (RR) 1.88; 95% CI 1.0 to 3.28).Only cognitive behavioural therapy is supported by reliable evidence (moderate strength of evidence) to produce responses to treatment similar to those of second-generation antidepressants (45.5% vs 44.2%; RR 1.10; 95% CI 0.93 to 1.30). All remaining comparisons of non-pharmacological treatments with second-generation antidepressants either led to inconclusive results or had substantial methodological shortcomings (low or insufficient strength of evidence).
Conclusions: In contrast to pharmacological treatments, the majority of non-pharmacological interventions for treating patients with MDD are not evidence based. For patients with strong preferences against pharmacological treatments, clinicians should focus on therapies that have been compared directly with antidepressants.
Trial Registration Number: International Prospective Register of Systematic Reviews (PROSPERO) registration number: 42016035580.
Download full-text PDF |
Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5623437 | PMC |
| http://dx.doi.org/10.1136/bmjopen-2016-014912 | DOI Listing |
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