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.
  
  
  OBJECTIVE
  To compare the benefits and harms of second-generation antidepressants and psychological, complementary and alternative medicine (CAM), and exercise treatments as first- and second-step interventions for adults with acute MDD.
  
  
  METHODS
  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databases (January 1990 to September 2015); trial registries and gray-literature databases were used to identify unpublished research.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  High dropout rates, dosing inequalities, small sample sizes, and poor assessment of adverse events limit confidence in the evidence.
  
  
  CONCLUSIONS
  Given their similar efficacy, CBT and antidepressants are both viable choices for initial treatment of MDD.
  
  
  BACKGROUND
  Agency for Healthcare Research and Quality.
authors: Gerald
authors: G
authors: Gartlehner
authors: Bradley N
authors: BN
authors: Gaynes
authors: Halle R
authors: HR
authors: Amick
authors: Gary N
authors: GN
authors: Asher
authors: Laura C
authors: LC
authors: Morgan
authors: Emmanuel
authors: E
authors: Coker-Schwimmer
authors: Catherine
authors: C
authors: Forneris
authors: Erin
authors: E
authors: Boland
authors: Linda J
authors: LJ
authors: Lux
authors: Susan
authors: S
authors: Gaylord
authors: Carla
authors: C
authors: Bann
authors: Christiane Barbara
authors: CB
authors: Pierl
authors: Kathleen N
authors: KN
authors: Lohr
mesh_terms: D000328:Adult; D018687:Antidepressive Agents, Second-Generation / Q000009:adverse effects / Q000627:therapeutic use*; D015928:Cognitive Behavioral Therapy; D000529:Complementary Therapies / Q000009:adverse effects; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000628:therapy*; D005081:Exercise Therapy / Q000009:adverse effects; D006801:Humans; D012074:Remission Induction
chemical_list: D018687:Antidepressive Agents, Second-Generation