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GPs should give depressed patients choice of drugs or therapy, says study

Talking therapy and antidepressant medication are equally effective for treating major depressive disorder, and therefore GPs should offer both as first-line treatment options to patients, researchers have said.

The study, published today in the BMJ, which compared the clinical outcomes for patients offered either cognitive behavioural therapy (CBT) or a second-generation antidepressant (SSRI, SNRI or other drugs targeting specific neurotransmitters) in isolation, found that there was no difference in responsiveness to treatment.

The researchers, who analysed results of 1,511 patients spread across 11 randomised controlled trials, found that ’available evidence suggests no difference in treatment effects of second-generation antidepressants and cognitive behavioral therapies, either alone or in combination, in major depressive disorder.’

Their report concluded: ’Given that patients may have personal preferences for one first-line treatment over the other, both treatments should be made accessible, either alone or in combination, to primary care patients with major depressive disorder.’

Lead author Dr Gerald Gartlehner, from Danube University, Austria, told Pulse: ’I think the most important point is that patients should have a choice. We now know that antidepressants are not better than CBT but this is not reflected in clinical guidelines for physicians yet (but will be). Doctors need to discuss the pros and cons of antidepressants and CBT with their patients. Some will still want antidepressants, others might choose CBT. The important point is that the decision should be based on informed decision making.’

 

Readers' comments (10)

  • Er....we already do. However, the choice of CBT carries a 12-18 month wait so the choice is often academic

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  • Wrong!
    NHS England should offer a choice. They don't fund therapy so there is an 18 month waiting list here, In practical terms therefore, there is no choice. How are GPs supposed to offer a choice when there is none and it is NHS England's fault?

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  • Dear Mrs Gloomy, Your choice today is an SSRI now or a 12 week wait just to have some semi-robotic instrument of the state ring you up and do six minutes (i've timed it) of telephone triage to determine you are a)depressed and b)might benefit from some CBT/counselling, which may or may not start sometime before the next general election. What will it be?

    I'm amazed the suicide rate is as low as it is, frankly. Course, it's these Doctors i blame......hangin's too good for 'em...... etc etc ad infinitum ad nauseam.

    University of Danube indeed. Waltz off, Professor.

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  • Vinci Ho

    Problem is this is called 'virtual reality bias': you would not expect in the study of these RCTs the selected subjects would have to wait for talking therapy , would you?
    I would want to believe that if both therapies are readily available , the outcomes would be similar.
    So the NICE's recommendation ,of talking therapy for mild to moderate depression and antidepressants are for moderate to severe , severe depression , is somehow 'realistic'!!

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  • We all offer a choice but in my area the wait for talking therapy is 6 months+.So we have effectively got no choice.Choice costs and in the time of austerity the choice is what the government want to fund adequately which at the current time IS NOT THE NHS!

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  • 18 month wait? Ours is less than 18 days!
    I can tell my patients how fantastically lucky they are to be depressed in Devon...that should cheer them up?

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  • GP's should stop prescribing antidepressants. This is the biggest scam of the 21st century.

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  • Wow
    Another study telling us what we all new 20 years ago
    Seriously unimpressed

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  • Yes. Would be super. But the Therapy should be very soon. And also many patients have said they did not get enough sessions ,First it was 10-12 sessions then I think cut to 6-8. Not enough for some people

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  • But yes,we have always offered these alternatives for many years. .Our practice had in house counsellors ,which were stopped and absorbed into the pct wide cbt therapy,however I do not believe severe depression will respond,the sort where people are not functioning normally and can only think of death and dying and being in a hole,those people need anti depressants

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