title: Nonpharmacologic Versus Pharmacologic Treatment of Adult Patients With Major Depressive Disorder: A Clinical Practice Guideline From the American College of Physicians.
abstract: METHODS
  The American College of Physicians (ACP) developed this guideline to present the evidence and provide clinical recommendations on the comparative effectiveness of treatment with second-generation antidepressants versus nonpharmacologic treatments for major depressive disorder in adults.
  
  
  METHODS
  This guideline is based on a systematic review of published, English-language, randomized, controlled trials from 1990 through September 2015 identified using several databases and through hand searches of references of relevant studies. Interventions evaluated include psychotherapies, complementary and alternative medicines (including acupuncture, ω-3 fatty acids, S-adenosyl-L-methionine, St. John's wort [Hypericum perforatum]), exercise, and second-generation antidepressants. Evaluated outcomes included response, remission, functional capacity, quality of life, reduction of suicidality or hospitalizations, and harms. The target audience for this guideline includes all clinicians, and the target patient population includes adults with major depressive disorder. This guideline grades the evidence and recommendations using ACP's clinical practice guidelines grading system.
  
  
  CONCLUSIONS
  ACP recommends that clinicians select between either cognitive behavioral therapy or second-generation antidepressants to treat patients with major depressive disorder after discussing treatment effects, adverse effect profiles, cost, accessibility, and preferences with the patient (Grade: strong recommendation, moderate-quality evidence).
authors: Amir
authors: A
authors: Qaseem
authors: Michael J
authors: MJ
authors: Barry
authors: Devan
authors: D
authors: Kansagara
mesh_terms: D000328:Adult; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use; D015928:Cognitive Behavioral Therapy; D000529:Complementary Therapies; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000628:therapy*; D005081:Exercise Therapy; D006801:Humans; D018570:Risk Assessment; D012720:Severity of Illness Index
chemical_list: D018687:Antidepressive Agents, Second-Generation