Cognitive behavioural therapy or antidepressants for acute depression?

Depression is an important and underappreciated cause of global morbidity and mortality. It is the second leading cause of years lost to disability, accounting for approximately 10% of all such losses.1 2 More than half of the roughly 1 million people worldwide who die from suicide each year have depression.3 Although reported point prevalence rates for major depressive disorder in primary care are of the order of 10%,4 the literature is unclear about which evidence based treatments are most effective.

In a linked paper (doi:10.1136/bmj.h6019), Amick and colleagues report a systematic review and meta-analysis of studies comparing second generation antidepressants and cognitive behavioural therapy (CBT) for the initial treatment of major depressive disorder.5 They found no substantial differences in short term efficacy and tolerability between the treatments. This is generally consistent with findings from previous meta-analyses, although (uniquely) this one is confined to second generation antidepressants. The authors highlight the fact that, despite …