SSRIs significantly increase the risk of both serious and non-serious adverse events .
The potential small beneficial effects seem to be outweighed by harmful effects .
Background The evidence on selective serotonin reuptake inhibitors ( SSRIs ) for major depressive disorder is unclear .
Methods Our objective was to conduct a systematic review assessing the effects of SSRIs versus placebo , ‘ active ’ placebo , or no intervention in adult participants with major depressive disorder .
Cognitive therapy vs medications in the treatment of moderate to severe depression.
BACKGROUND There is substantial evidence that antidepressant medications treat moderate to severe depression effectively , but there is less data on cognitive therapy 's effects in this population . OBJECTIVE To compare the efficacy in moderate to severe depression of antidepressant medications with cognitive therapy in a placebo-controlled trial . DESIGN R and om assignment to one of the following : 16 weeks of medications ( n = 120 ) , 16 weeks of cognitive therapy ( n = 60 ) , or 8 weeks of pill placebo ( n = 60 ) . SETTING Research clinics at the University of Pennsylvania , Philadelphia , and V and erbilt University , Nashville , Tenn. PATIENTS Two hundred forty out patients , aged 18 to 70 years , with moderate to severe major depressive disorder . INTERVENTIONS Some study subjects received paroxetine , up to 50 mg daily , augmented by lithium carbonate or desipramine hydrochloride if necessary ; others received individual cognitive therapy . MAIN OUTCOME MEASURE The Hamilton Depression Rating Scale provided continuous severity scores and allowed for design ations of response and remission . RESULTS At 8 weeks , response rates in medications ( 50 % ) and cognitive therapy ( 43 % ) groups were both superior to the placebo ( 25 % ) group . Analyses based on continuous scores at 8 weeks indicated an advantage for each of the active treatments over placebo , each with a medium effect size . The advantage was significant for medication relative to placebo , and at the level of a nonsignificant trend for cognitive therapy relative to placebo . At 16 weeks , response rates were 58 % in each of the active conditions ; remission rates were 46 % for medication , 40 % for cognitive therapy . Follow-up tests of a site x treatment interaction indicated a significant difference only at V and erbilt University , where medications were superior to cognitive therapy . Site differences in patient characteristics and in the relative experience levels of the cognitive therapists each appear to have contributed to this interaction . CONCLUSION Cognitive therapy can be as effective as medications for the initial treatment of moderate to severe major depression , but this degree of effectiveness may depend on a high level of therapist experience or expertise
SSRIs significantly increase the risk of both serious and non-serious adverse events .
The potential small beneficial effects seem to be outweighed by harmful effects .
Background The evidence on selective serotonin reuptake inhibitors ( SSRIs ) for major depressive disorder is unclear .
Methods Our objective was to conduct a systematic review assessing the effects of SSRIs versus placebo , ‘ active ’ placebo , or no intervention in adult participants with major depressive disorder .