'No difference' in effects of antidepressants and CBT, study suggests

There is 'no difference' in the effects of second generation antidepressants and CBT, a review of available evidence has suggested, but BMA leaders stress GPs should not feel pressured to stop prescribing antidepressants.

CBT is as effective in treating major depression as second generation antidepressants including selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors and others, research published in the BMJ has suggested.

But leading GPs have said GPs should not feel under pressure for prescribing antidepressants to patients for major depression, as more research must be done before the evidence becomes robust enough to prompt changes to recommended guidance.

The US study, a systematic review of 11 randomised controlled trials encompassing 1,500 patients, concluded that there was ‘no difference’ in the benefits and harms of second generation antidepressants over CBT for patients with major depressive disorder.

Given they found that both treatments produce similar benefits, the researchers said GPs should ensure that both options are made available to patients either separately or in combination.

CBT and antidepressants

But they added that the results should be ‘interpreted cautiously’ given the low strength of evidence in some of the studies that fed into the review.

Dr Andrew Green, chairman of the GPC clinical and prescribing subcommittee, said the wide confidence limits made it ‘difficult to draw firm conclusions’ from the study, but if verified it could incite changes to current guidance.

He said: ‘GPs are often criticised for treating depression with medication rather than offering alternatives, but in correctly selected patients drug therapy is safe and effective, and has the advantage of having no delay in treatment and often rapid responses.

‘This can help patients maintain their employment and personal relationships which are so important yet so vulnerable during episodes of depression.

‘In other areas of medicine we are urged to use the intervention with the ‘lowest acquisition cost’, if this principle were applied here then if this study is true guidance might need to change, however the political implications of such a change would be significant given the strong feelings that this issue can raise.’

The researchers said: ‘Given that the benefits of second generation antidepressants and cognitive behavioural therapy do not seem to differ significantly in treating major depressive disorder and that primary care patients may have personal preferences for one first line treatment over the other, both treatments should be made accessible, either alone or in combination, to primary care patients with major depressive disorder.’

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