Nonpharmacological Versus Pharmacological Treatments for Adult Patients With Major Depressive Disorder - Psychotherapy Interventions

Project Summary Title and Description

Nonpharmacological Versus Pharmacological Treatments for Adult Patients With Major Depressive Disorder - Psychotherapy Interventions
Comparison of the benefits and harms of second-generation antidepressants (SGAs), psychological treatment options as first-step interventions for adult outpatients with acute -phase major depressive disorder (MDD), and as second-step interventions for patients with MDD who did not achieve remission after a first treatment attempt with SGAs.
Authors of Report
Methodology description
For the Systematic Review, we worked with a Technical Expert Panel representing the consumer perspective and professional organizations, researchers, and payers with expertise in psychopharmacology, psychotherapy, complementary and alternative medicine (CAM), and exercise therapies for depression, to finalize our methodological approach. Five literature databases were searched and dually screened following established inclusion/exclusion criteria. Individual trials were abstracted and dually rated for risk of bias. We qualitatively synthesized the data by each individual comparison eligible within each Key Question, and when data were sufficient we augmented findings with quantitative analyses. We graded the strength of evidence for outcomes deemed as important or critical for decisionmaking.
PMID of the project: 26764438 Link to project materials on the AHRQ website: Psychotherapy treatment is one of the three groups of treatments examined under this review, but due to the limitations of SRDR we have to enter each as a separate project. There are four Key Questions for the Systematic Review. Questions 5 through 10 are only used as a vehicle to be able to upload the data. Data were imported retrospectively into SRDR using the SRDR Data Import Tool.
Funding Source
Agency for Heatlhcare Quality and Research

Key Questions

1. KQ 1a. In adult patients with major depressive disorder (MDD) who are undergoing an initial treatment attempt, what is the effectiveness of second-generation antidepressant (SGA) monotherapy compared with the effectiveness of either nonpharmacological monotherapy or combination therapy (involving nonpharmacological treatments with or without an SGA)? KQ 1b. Does comparative treatment effectiveness vary by MDD severity?
2. KQ 2a. In adult patients with MDD who did not achieve remission following an initial adequate trial with one SGA, what is the comparative effectiveness of second-step therapies*? KQ 2b. Does comparative treatment effectiveness vary by MDD severity? * Any comparison that involves an eligible intervention (whether as a monotherapy or a combination therapy) and compares an intervention with one involving an SGA is eligible
3. KQ 3a. In adult patients with MDD, what are the comparative risks of harms of these treatment options—: (1) For those undergoing an initial treatment attempt? (2) For those who did not achieve remission following an initial adequate trial with an SGA? KQ 3b. Do the comparative risks of treatment harms vary by MDD severity?
4. KQ 4. Do the benefits and risks of harms of these treatment options differ by subgroups of patients with MDD defined by common accompanying psychiatric symptoms (coexisting anxiety, insomnia, low energy, or somatization) or demographic characteristics (age, sex, race, or ethnicity)?
5. Outcomes for KQ1a
6. Outcomes for KQ2
7. Outcomes for KQ3 for KQ1 Studies
8. Outcomes for KQ4
9. Outcomes for KQ3 (KQ2 studies)
10. Outcomes for KQ1b

Associated Extraction Forms

Associated Studies (each link opens a new tab)

Toward a neuroimaging treatment selection biomarker for major depressive disorder.2013
Behavioural activation v. antidepressant medication for treating depression in Iran: randomised trial.
Short-term dynamic psychotherapy versus pharmacotherapy for major depressive disorder: a randomized, placebo-controlled trial.2012
Predictors and moderators of time to remission of major depression with interpersonal psychotherapy and SSRI pharmacotherapy.2011
Patients' depression treatment preferences and initiation, adherence, and outcome: a randomized primary care study.2009
Short-term psychodynamic psychotherapy and fluoxetine in major depressive disorder: a randomized comparative study.2008
Rational emotive behavior therapy, cognitive therapy, and medication in the treatment of major depressive disorder: a randomized clinical trial, posttreatment outcomes, and six-month follow-up.2008
Speed of action: the relative efficacy of short psychodynamic supportive psychotherapy and pharmacotherapy in the first 8 weeks of a treatment algorithm for depression.2008
Combination treatment for acute depression is superior only when psychotherapy is added to medication.2007
Differences in brain glucose metabolism between responders to CBT and venlafaxine in a 16-week randomized controlled trial.
Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression.2006
Cognitive reactivity to sad mood provocation and the prediction of depressive relapse.2006
Cognitive therapy vs medications in the treatment of moderate to severe depression.2005
Treating depression in predominantly low-income young minority women: a randomized controlled trial.
Randomised controlled trial of problem solving treatment, antidepressant medication, and combined treatment for major depression in primary care.2000
Neurocognitive changes in depressed patients in psychodynamic psychotherapy, therapy with fluoxetine and combination therapy.2013
Effects of pharmacotherapy and psychotherapy in depressed primary-care patients: a randomized, controlled trial including a patients' choice arm.2010
Moderators of remission with interpersonal counselling or drug treatment in primary care patients with depression: randomised controlled trial.2014
Effects of combined pharmacotherapy and psychotherapy for improving work functioning in major depressive disorder.2013
Efficacy of pharmacotherapy and cognitive therapy, alone and in combination in major depressive disorder.2008

Downloadable Data Content

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