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Treatment of depression: SMB sees slight advantage with medications

Various options are available to treat depression, namely psychotherapy and/or drug therapy with antidepressants. In a new HTA report, the Swiss Medical Board investigated the efficacy, safety, benefit-risk ratio and health economic impact of the two treatment options. Based on the available data, the Swiss Medical Board concludes that for the treatment of major depressive disorder after the acute phase, antidepressants are recommended and a combination of antidepressants and psychotherapy is recommended under certain conditions.

Major depressive disorder is one of the most common mental illnesses and represents a significant social and health economic burden. Approximately one in three persons over the age of 15 in Switzerland will suffer from major depressive disorder during their lifetime. Treatment options include psychotherapy and/or antidepressant medication. Treatment is provided in three phases: an acute phase, which lasts 6 to 12 weeks and aims at remission; the continuation phase, which lasts 4 to 9 months and aims at preventing relapse; and the maintenance phase, which may last years and aims at preventing relapse or chronic depression. Current treatment recommendations are largely based on short term studies that focus on the acute treatment phase. Little is known about the benefits and harms of either therapy after 12 weeks of treatment. 

In a new HTA report, the Swiss Medical Board assesses the clinical effectiveness, safety, and health economic impact of antidepressants and psychotherapy alone or in combination in patients treated beyond the acute phase. 

Forty-two studies were available for analysis of clinical efficacy and safety, although most were of rather low quality. Both antidepressants and psychotherapy appear to be clinically effective beyond the acute treatment phase compared with placebo, but neither method was clearly superior to the other. The council of experts concluded that both antidepressants and psychotherapy have desirable but variable clinical effects. Uncertainties remain regarding clinical safety and differences in the potential benefits and potential harms of  antidepressants compared with psychotherapy.

The health economic analysis included 33 studies. It is reasonable to assume that, given the similar clinical efficacy and higher cost of psychotherapy, treating all patients exclusively with antidepressants would result in moderate savings. However, the choice of therapy may be significantly influenced by several factors, including symptom severity, patient preferences, cost, availability of psychotherapy, and acceptability. On the basis of the available data, the council of experts concludes that for the treatment of major depressive disorder after the acute phase, antidepressants are recommended and a combination of antidepressants and psychotherapy is recommended under certain conditions.

The Assessment and Appraisal Reports can be consulted under the following link.