Table 3.

 Strength of evidence and summary of findings

Comparison and outcome of interest	Strength of evidence*	Findings
Second generation antidepressant versus cognitive behavioral therapy monotherapy comparisons
Remission	Low	Results from direct comparisons in three trials indicate that no differences in remission exist between second generation antidepressants and cognitive behavioral therapy monotherapy (risk ratio 0.98, 95% CI 0.73 to 1.32)
Response	Moderate	Results from direct comparisons in five trials indicate that no substantial differences in response exist between second generation antidepressants and cognitive behavioral therapy monotherapy (risk ratio 0.91, 0.77 to 1.07)
Functional capacity	Low	Results from one trial indicate that no substantial differences in functional capacity exist between second generation antidepressants and cognitive behavioral therapy monotherapy
Overall risk of adverse events	Insufficient	On the basis of one trial with few events, the evidence is insufficient to draw conclusions
Overall discontinuation of treatment	Moderate	Results from direct comparisons in four trials indicate that no significant differences exist in overall discontinuation between patients treated with second generation antidepressants and those treated with cognitive behavioral therapy (risk ratio 1.00, 0.55 to 1.81)
Discontinuation of treatment because of adverse events	Low	Results from direct comparisons in three trials indicate that patients treated with second generation antidepressants have a numerically but not statistically significant higher rate of discontinuation because of adverse events than those treated with cognitive behavioral therapy (risk ratio 2.54, 0.39 to 16.47)
Second generation antidepressant versus combination of second generation antidepressant and cognitive behavioral therapy
Remission	Low	Results from direct comparisons in two trials indicate that no substantial differences in remission exist between second generation antidepressants and second generation antidepressants combined with cognitive behavioral therapy (risk ratio 1.06, 0.82 to 1.38)
Response	Low	Results from direct comparisons in two trials indicate that no substantial differences in response exist between second generation antidepressants and second generation antidepressants combined with cognitive behavioral therapy (risk ratio 1.03, 0.85 to 1.26)
Functional capacity	Low	Results from one trial indicate that the combination of second generation antidepressant with cognitive behavioral therapy results in statistically significantly greater improvement on 3/4 work functioning measures than second generation antidepressant alone
Overall discontinuation of treatment	Low	Results from direct comparisons in two head to head trials indicate that no significant differences exist in overall discontinuation between patients treated with second generation antidepressants and those treated with cognitive behavioral therapy (risk ratio 0.77, 0.37 to 1.60)
Discontinuation of treatment because of adverse events	Low	Results from direct comparisons in two head to head trials indicate that no significant differences exist in discontinuation because of adverse events between patients treated with second generation antidepressants and those treated with cognitive behavioral therapy (risk ratio 2.93, 0.72 to 11.91)

*Grades (high, moderate, low, or insufficient) are based on methods guidance for US Agency for Healthcare Research and Quality for the Evidence-based Practice Center program.⁴⁴