People with major depression can try CBT or newer drugs, scientists say

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In a new guideline from The American College of Physicians, scientists give recommendations for treatments of major depressive disorder (MDD).

The team recommends the use of either cognitive behavioral therapy (CBT) or second-generation antidepressants (SGAs) as initial treatment in adults with moderate to severe MDD.

The team suggests the combination of both, as an alternative initial treatment option.

The scientists also suggest initiating CBT in adults with mild major depression. They stressed the importance of informed decision-making when selecting treatment and taking patient preferences into account.

In summary, the team recommends:

Monotherapy with either CBT or an SGA as initial treatment in patients in the acute phase of moderate to severe MDD (strong recommendation, moderate-certainty evidence).

Combination therapy with CBT and an SGA as initial treatment in patients in the acute phase of moderate to severe MDD (conditional recommendation; low certainty-evidence).

Monotherapy with CBT as initial treatment in patients in the acute phase of mild MDD (conditional recommendation; low-certainty evidence).

One of the following options for patients in the acute phase of moderate to severe MDD who did not respond to initial treatment with an adequate dose of an SGA:

switching to or augmenting with CBT (conditional recommendation; low-certainty evidence),

switching to a different SGA or augmenting with a second pharmacological treatment (see Clinical Considerations) (conditional recommendation; low-certainty evidence).

The informed decision on the options should be personalized and based on a discussion of potential treatment benefits, harms, adverse effect profiles, cost, feasibility, patients’ specific symptoms (such as insomnia, hypersomnia, or fluctuation in appetite), co-morbidities, concomitant medication use, and patient preferences

ACP’s Clinical Guidelines Committee is planning to maintain this topic as a living guideline with literature surveillance and periodic updating of the systematic review and clinical recommendations.

If you care about depression, please read studies about vegetarianism linked to higher risk of depression, and Vitamin D could help reduce depression symptoms.

For more information about mental health, please see recent studies about common medications for anxiety, and results showing two in five adults with ADHD have excellent mental health.

The study was conducted by Amir Qaseem et al and published in the Annals of Internal Medicine.

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