The best remedy for depression might very well be an either/or choice, according to a new review published in The BMJ Tuesday.

Analyzing and combining the results from 11 previous studies that compared antidepressants to cognitive behavioral therapy (CBT) as a treatment for major depression, the authors essentially found no major differences in patient outcomes between the two, even when drugs were used in combination with CBT. Whether it was the level of treatment response, or the percentage of treated people who subsequently relapsed into depression, CBT and medication were seemingly matched across the board.

“The 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,” the authors 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.”

Evenly Matched

Though earlier reviews on the topic have come to similar conclusions, the BMJ study is the first to explicitly examine the research behind comparisons of the current line of antidepressants to CBT. Because earlier studies have shown similar success rates among different classes of antidepressants — whether they’re selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs) — the researchers felt comfortable bunching them together as one group.

Similarly, while there are hundreds of different therapy methods in existence, CBT is considered the most empirically supported psychotherapy available. According to the study, CBT is broadly defined as a series of techniques that teach patients “how to replace dysfunctional thoughts and behaviors with more adaptive ones, which can reduce distress and improve mood.”

To conduct their review, the researchers specifically keyed in on studies comparing CBT and medication for the initial treatment of an ongoing episode of major depressive disorder in adults. While that scope enabled them to look at more than 1,500 people, it also makes it difficult to extrapolate their findings to the very young or elderly. Likewise, few of the trials studied people suffering from suicidal ideation or other underlying medical conditions. Even with that more narrow outline, the authors often found the studies had “methodological shortcomings that may limit confidence in some of the findings.”

Each treatment method comes with its pros and cons. Antidepressants, while a more popular and easily available option, come with any number of unpleasant side effects that can discourage patients from taking their full course. CBT, on the other hand, often takes longer to complete, and its quality can vary dramatically from one therapist to another. Though the difference wasn’t statistically significant, there was a lower chance of relapse following successful treatment from CBT over medication detected in several studies reviewed by the authors — with one trial finding a 40 percent relapse rate in the first year after CBT, and a 60 percent relapse rate for antidepressants.

Because patients often respond better to the treatment they personally prefer, the researchers advocate a broadening of therapeutic services in primary care settings, since many physicians already have the ability to prescribe antidepressants as they see fit. “[Such a move] has the potential to improve use of psychiatric consultations and therapy and to enhance coordination of care between primary care clinicians and mental health professionals,” they wrote. “It may also have additional downstream effects of reducing the stigma associated with mental illness in general, empowering patients to tackle the symptoms and problems associated not only with depression but also with other mental health related concerns and encouraging them to seek and maintain treatment more quickly at an earlier stage of their illness.”

Source: Amick H, Gartlehner G, Gaynes B, et al. Comparative benefits and harms of second generation antidepressants and cognitive behavioral therapies in initial treatment of major depressive disorder: systematic review and meta-analysis. The BMJ. 2015.