Many comparisons had low or insufficient evidence to draw conclusions. Nevertheless, for most comparisons, the overall findings did not show statistical difference in benefits but did indicate lower risk of adverse events in nonpharmacologic treatment options. However, omega-3-fatty acids seemed to have lower effectiveness than SGAs; the combination of SGAs with acupuncture appeared to have higher response rather than SGA monotherapy; and the combination of SGAs with interpersonal psychotherapy appeared to have better effectiveness than SGA monotherapy.  Moreover, the data did not indicate differences in comparative effectiveness between SGAs and nonpharmacologic interventions in patients with severe MDD.

The researchers noted a “striking” paucity in comparative data regarding which treatment options are most effective in those needing second-step treatment (about 79% of patients with MDD). They added that certain interventions, such as medication and St. John’s wort, require physician supervision and monitoring in light of potential side effects and drug interactions. An exercise regimen has “enhanced potential for increasing physical well-being and expanding social interactions,” which may be an “added incentive” to encourage this intervention, they said.

Conclusion

The USPSTF statement emphasized that “clinical decisions involve more considerations than evidence alone” and that clinicians should “individualize decision making to the specific patient or situation.”

Dr. Schlam agrees. “The primary care physician will evaluate the patient for other medical conditions that can cause symptoms similar to depression or exacerbate a depressive disorder.” He notes that patients have a “long-term relationship with their primary care physicians and feel comfortable.” For this reason, the primary care physician is ideally suited to make individualized decisions to treat the patient’s depression.

References

  1. Agency for Healthcare Research and Quality (AHRQ). Nonpharmacological versus pharmacological treatments for adult patients with major depressive disorder. Comparative Effectiveness Review #161. Available at: http://effectivehealthcare.ahrq.gov/ehc/products/568/2152/major-depressive-disorder-executive-151202.pdf. Accessed: January 30, 2016.
  2. Siu AL; US Preventive Services Task Force (USPSTF), Bibbins-Domingo K, Grossman DC, Baumann LC, Davidson KW, Ebell M, García FA, Gillman M, Herzstein J, Kemper AR, Krist AH, Kurth AE, Owens DK, Phillips WR, Phipps MG, Pignone MP. Screening for Depression in Adults: US Preventive Services Task Force Recommendation Statement. JAMA. 2016 Jan 26;315(4):380-7.
  3. Thase ME. Recommendations for screening for depression in adults. JAMA. 2016;315(4):349-350.