Annals of Internal MedicineNonpharmacologic and Pharmacologic Treatments of Adult Patients with Major Depressive Disorder

The analysis found similar benefits for most nonpharmacologic treatments and antidepressants as first-step treatments in MDD. As 1st-line therapy, cognitive behavioral therapies (CBTs) were similar in response to second-generation antidepressants (SGAs) in terms of benefit and remission rates, but discontinuation for adverse events was higher with SGAs. The complementary and alternative medicine interventions St. Johns Wart and acupuncture were also similar to SGAs in terms of response and remission. However, the combination of acupuncture and SGAs yielded higher remission rates. Exercise was also similar to SGAs in remission rates; adding exercise to SGAs gave no added benefit. Antidepressants had a higher risk of discontinuation because of adverse events. For second-step therapies, different switching and augmentation strategies provided similar symptomatic relief.