New Guidelines for Depression Treatment

Patients with major depressive disorder (MDD) are often prescribed one of two treatments: antidepressants or therapy. But which one works best?

Both, according to new guidelines on depression treatment from the American College of Physicians. Both methods appeared to be similarly effective in a recent review of existing studies — the findings of which informed the guidelines.

The gist of the new guidelines? Because antidepressant drugs and cognitive behavioral therapy (CBT) appeared equally effective, doctors should assess individual patients to determine what approach would work best in their case.

"Incorporating these principles and decision aids could address the current mismatch between the treatment desired and the treatment received by patients with depression," wrote John W. Williams, Jr., MD, of the Durham Veterans Affairs Medical Center, and Gary Maslow, MD, of Duke University, in an editorial about the new guidelines.

Drs. Williams and Maslow added, "In the current era of dynamic change in the health care system, the opportunities and incentives to improve the care and health of persons with depression are tangible."

MDD isn't just sadness when something bad happens — it's severe and constant enough to affect a patient's daily life. CBT, in which a therapist helps a patient redirect negative thoughts, is thought to be an effective treatment free of harmful side effects.

Antidepressants (like mirtazapine, nefazodone and bupropion) are also effective in many cases. But they can, in some cases, have unwanted side effects.

In the end, no two patients are exactly alike. Some patients respond more to particular treatments. In a press release, Wayne J. Riley, MD, president of the American College of Physicians, said doctors should discuss "... treatment effects, adverse effect profiles, costs, accessibility, and preferences with patients.”

The new guidelines, study and editorial were published in the Annals of Internal Medicine.

The Agency for Healthcare Research and Quality funded the study. No conflicts of interest were disclosed.