Note to myself and my readers: This is an excellent review of depression. In addition, reviewing Figure 1 and Tables 1 through 5 [which I have included in this post after the abstract] allow for an excellent quick review of the article.
Today, I review, link to, and excerpt from Management of Depression in Adults:
A Review [PubMed Abstract] [Full-Text HTML] [Full-Text PDF]. JAMA. 2024 Jul 9;332(2):141-152. doi: 10.1001/jama.2024.5756.
All that follows is from the above article.
AbstractImportance Approximately 9% of US adults experience major depression each year, with a lifetime prevalence of approximately 17% for men and 30% for women.
Observations Major depression is defined by depressed mood, loss of interest in activities, and associated psychological and somatic symptoms lasting at least 2 weeks. Evaluation should include structured assessment of severity as well as risk of self-harm, suspected bipolar disorder, psychotic symptoms, substance use, and co-occurring anxiety disorder. First-line treatments include specific psychotherapies and antidepressant medications. A network meta-analysis of randomized clinical trials reported cognitive therapy, behavioral activation, problem-solving therapy, interpersonal therapy, brief psychodynamic therapy, and mindfulness-based psychotherapy all had at least medium-sized effects in symptom improvement over usual care without psychotherapy (standardized mean difference [SMD] ranging from 0.50 [95% CI, 0.20-0.81] to 0.73 [95% CI, 0.52-0.95]). A network meta-analysis of randomized clinical trials reported 21 antidepressant medications all had small- to medium-sized effects in symptom improvement over placebo (SMD ranging from 0.23 [95% CI, 0.19-0.28] for fluoxetine to 0.48 [95% CI, 0.41-0.55] for amitriptyline). Psychotherapy combined with antidepressant medication may be preferred, especially for more severe or chronic depression. A network meta-analysis of randomized clinical trials reported greater symptom improvement with combined treatment than with psychotherapy alone (SMD, 0.30 [95% CI, 0.14-0.45]) or medication alone (SMD, 0.33 [95% CI, 0.20-0.47]). When initial antidepressant medication is not effective, second-line medication treatment includes changing antidepressant medication, adding a second antidepressant, or augmenting with a nonantidepressant medication, which have approximately equal likelihood of success based on a network meta-analysis. Collaborative care programs, including systematic follow-up and outcome assessment, improve treatment effectiveness, with 1 meta-analysis reporting significantly greater symptom improvement compared with usual care (SMD, 0.42 [95% CI, 0.23-0.61]).
Conclusions and Relevance Effective first-line depression treatments include specific forms of psychotherapy and more than 20 antidepressant medications. Close monitoring significantly improves the likelihood of treatment success.
aIncludes citalopram, escitalopram, fluoxetine, fluvoxamine, sertraline, desvenlafaxine, duloxetine, levomilnacipran, venlafaxine, mirtazapine, nefazodone, trazodone, vilazodone, vortioxetine, and bupropion.
bCognitive behavioral therapy, interpersonal counseling, problem-solving therapy, and life review therapy.
cBehavioral therapy, cognitive therapy, mindfulness-based cognitive therapy, interpersonal therapy, psychodynamic psychotherapies, and supportive therapy.
dGroup cognitive or individual cognitive behavioral therapy, behavioral activation, or mindfulness and meditation.
eAcceptance and commitment therapy, behavioral activation, cognitive behavioral therapy, interpersonal therapy, mindfulness-based cognitive therapy, problem-solving therapy, and short-term psychodynamic psychotherapy (weak recommendation regarding choice of psychotherapy).
