Antidepressants Not Superior to Psychotherapy for Severe Depression

In their guidelines for the treatment of depression, both the American Psychiatric Association (APA) and the British Association for Psychopharmacology suggest that while “psychotherapy is sufficient for treating mild depression, antidepressant medications (ADMs) should be used to treat severe depression in the context of major depressive disorder.” These guidelines are based largely on the results of a randomized control trial conducted by the NIMH. However, this latest meta-analysis reveals that the difference in treatment outcomes observed in the NIMH trials “were not observed in several other randomized clinical trials (RCTs) of acute-phase treatment.”

While previous meta-analyses have attempted to compare ADMs and CBT for depression, the latest study is unique in that the researchers were able to obtain patient-level data, giving the study “more power to examine accurately moderators of treatment outcomes.” The researchers reviewed 16 studies that provided individual patient-level data and eight that did not. All told, the sample included data on 1,700 participants.

The results of the analysis show no significant differences between antidepressants and CBT in response to treatment or remission in patients with severe depression. “In total, 63% of patients in the ADM condition and 58% of patients in the CBT condition responded to treatment, and 51% of patients in the ADM condition and 47% of patients in the CBT condition met criteria for remission.”