Table 2.
Second generation antidepressants versus cognitive behavioral therapy: trial characteristics, main outcomes, and risk of bias ratings
| First author, year | Sample size*; duration (weeks) | Total sample mean baseline severity (HRSD unless otherwise indicated) | Second generation antidepressant (dose, mg/day); psychotherapy subtype (No of sessions) | Response† (%) and P value | Remission† (%) and P value | Mean change in HRSD score from baseline and P value | Risk of bias rating |
|---|---|---|---|---|---|---|---|
| David et al, 200832; Sava et al, 200931 | 170; 14 treatment, 36 follow-up | 22.5 | Fluoxetine (40-80); cognitive therapy (20), rational emotive therapy (20) | At 14 weeks: v cognitive therapy: 58 v 63 (P>0.05); v rational emotive therapy: 58 v 65 (P>0.05) | At 14 weeks: v cognitive therapy: 47 v 50 (P>0.05); v rational emotive therapy: 47 v 44 (P>0.05) | At 14 weeks: v cognitive therapy: −12.6 v −14.3 (P>0.05); v rational emotive therapy: −12.6 v −14.3; (P>0.05) | Medium |
| DeRubeis et al, 200537; Leykin et al, 200734; Landenberger, 200241 | 180; 8‡ | 23.4 | Paroxetine (10-50); cognitive therapy (20-28) | 50 v 43 (P=0.40) | Not reported | Effect size estimate: 0.16 (favors second generation antidepressant) (P=0.46) | Medium for response and remission; high for change in HRSD§ |
| Dimidjian, 200635 | 145; 16 | 20.7 | Paroxetine (10-50); cognitive therapy (24) | 43 v 58 (P=not reported) | 27 v 42 (P=not reported) | Not reported¶ | Medium |
| Hegerl, 201040 | 48; 10 | 16.1 | Sertraline (50-200); cognitive behavioral therapy (14) | 38 v 50 (P=not reported) | Not reported | −6.5 v −8.8 (P=not reported) | Medium for response and remission; high for change in HRSD |
| Kennedy et al, 200733 | 31; 16 | 20.5 | Venlafaxine (75-225); cognitive behavioral therapy (16) | 64 v 41 (P=not reported) | 57 v 29 (P=not reported) | −12.9 v −10.8 (P=not reported) | High** |
| Lam et al, 201342 | 105; 12 | Montgomery-Åsberg Depression Rating Scale: 27.6 | Escitalopram (10-20); cognitive behavioral therapy (via telephone) (8) + escitalopram (10-20) | 61 v 63 (P=0.86) | 53 v 56†† (P=0.74) | Montgomery-Åsberg Depression Rating Scale: −14.3 v −15.7 (P=0.60) | Low |
| McGrath et al, 201330 | 82; 12 | 18.8 | Escitalopram (10-20); cognitive behavioral therapy (16) | 60 v 57 (P=not reported) | 28 v 29 (P=not reported) | Not reported | High‡‡ |
| Mynors-Wallis et al, 200039 | 151; 52 | 20.3 | Fluvoxamine (100-150) or paroxetine (10-40); problem solving therapy (provided by general practitioner) (6); problem solving therapy (provided by nurse) (6); problem solving therapy (provided by nurse) (6) + fluvoxamine (100-150) or paroxetine (10-40) | At 12 weeks: 78 v 64 v 69 v 74 (P=not reported) | At 12 weeks: 67 v 51 v 54 v 6 (P=not reported) | −14.0 v. −12.0 v −11.8 v −12.3 (P>0.05) | Medium |
| Segal et al., 200636 | 301; 24 treatment, 96 follow-up | 19.5 | Sertraline (50-200), paroxetine (20-50), or venlafaxine (75-225); cognitive behavioral therapy (20) | At 24 weeks: 80 v 72 (P=not reported) | At 24 weeks§§: 71 v 61 (P=not reported) | Not reported | |
| Shamsaei et al, 200843 | 120; 8 | Beck Depression Inventory: 42.8 | Citalopram (20); cognitive therapy (8); citalopram (20) + cognitive therapy (8) | Not reported | Not reported | Not reported | High*** |
| Miranda J et al, 200338 | 178; 4††† | 16.9 | Paroxetine (10-50); cognitive behavioral therapy (8) | Not reported | Not reported | −5.0 v −2.1 (P=0.17) |
HRSD=Hamilton Rating Scale for Depression.
*Total number of randomized participants in relevant arms of trial.
†Response (≥50% decrease in depressive severity) and remission (as defined by authors of individual trials) were measured using HRSD unless indicated otherwise.
‡Non-responders were switched to and/or augmented with another drug at 8 weeks.
§For dropouts, only data gathered before attrition were used in continuous outcome models.
¶Continuous data were provided only stratified by depression severity.
**High attrition; completers analysis; difference in baseline age between groups.
††Response was defined as ≥50% decrease in MDRS; remission was defined as MDRS≤12.
‡‡High attrition; completers analysis; no baseline data for part of population.
§§Definition of response was not reported.
¶¶Very high attrition; completers analysis; unclear randomization method.
***Several important aspects of study design and analysis not reported.
†††Although patients received second generation antidepressant for 8 weeks, only 4 week time point was reported.