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Comparing antidepressants and behaviour therapy

December 8, 2015

Sunnybrook psychiatrists weighed in on a review of treatment options for severe depression in an editorial published in today’s issue of the British Medical Journal (BMJ).

The editorial accompanied a study led by a team at Danube University that analyzed the results of 11 randomized controlled trials, each trial comparing second-generation antidepressants (the Prozac family of drugs) and cognitive behavioural therapy (CBT) for the treatment of major depressive disorder.

The study found the available evidence suggests no statistically significant difference in response to treatment with antidepressants or CBT for patients with major depressive disorder.

In the accompanying editorial, Sunnybrook psychiatrists Drs. Mark Sinyor, Ari Zaretsky and Mark Fefergrad say both options look equally effective, although evidence is limited. The current meta-analysis study involved a total of 1,511 patients.

They advocate for more high quality research comparing antidepressants with CBT in acute depression: “We need better evidence to be able to tease out whether certain patients will respond preferentially to either treatment,” says Dr. Sinyor.

In the meantime, they say policy makers “must acknowledge the World Health Organization’s projection that major depressive disorder will be the leading cause of disease burden worldwide by 2030 by taking more meaningful steps towards primary prevention.”

They believe these steps should include efforts “to correct social antecedents of major depressive disorder such as poverty and lack of education, along with improved mental health curriculums in schools.” Students could also be taught basic CBT or other interventions such as mindfulness, “with the aim of preventing symptoms rather than relying on treatment once symptoms start.”

Given that patients may have personal preferences for one first line treatment over the other, both treatments “should be made accessible to primary care patients with major depressive disorder”.

Treatment is often started in a primary care setting, usually with second-generation antidepressant drugs. CBT is a specialized talk therapy that works to help patients solve problems through a greater understanding of how their thoughts, feelings and behaviour interact.

Canadian studies looking at lifetime incidence of major depression found that 7.9 to 8.6 per cent of adults over 18 years of age and living in the community met the criteria for a diagnosis of major depression at some time in their lives. (Canadian Psychiatric Association, 2001, quoted on the Public Health Agency of Canada website)

Read the editorial

Read the study 

Dr. Mark Sinyor