Article pour les cliniciens

Comparaison des avantages et des inconvénients des antidépresseurs, des traitements psychologiques, complémentaires et de l'activité physique pour les dépressions majeures : un rapport de l'American College of Physicians basé sur les données probantes pour un guide de pratique clinique.

  • Gartlehner G
  • Gaynes BN
  • Amick HR
  • Asher GN
  • Morgan LC
  • Coker-Schwimmer E, et al.
Ann Intern Med. 2016 Mar 1;164(5):331-41. doi: 10.7326/M15-1813. Epub 2015 Dec 8. (Review)
PMID: 26857743
Lire le résumé Lire résumé des données probantes Lire le texte intégral
  • - MF/MG/Santé mentale
    Relevance - 6/7
    Intérêt médiatique  - 5/7
  • Médecine interne (voir sous-spécialités ci-dessous)
    Relevance - 6/7
    Intérêt médiatique  - 5/7
  • Psychiatrie
    Relevance - 6/7
    Intérêt médiatique  - 5/7
  • Médecine familiale (MF)/Médecine générale (MG)
    Relevance - 6/7
    Intérêt médiatique  - 3/7
  • Médecine interne générale - Soins primaires
    Relevance - 6/7
    Intérêt médiatique  - 3/7

Résumé (en anglais)

BACKGROUND: Primary care patients and clinicians may prefer options other than second-generation antidepressants for the treatment of major depressive disorder (MDD). The comparative benefits and harms of antidepressants and alternative treatments are unclear.

PURPOSE: To compare the benefits and harms of second-generation antidepressants and psychological, complementary and alternative medicine (CAM), and exercise treatments as first- and second-step interventions for adults with acute MDD.

DATA SOURCES: English-, German-, and Italian-language studies from multiple electronic databases (January 1990 to September 2015); trial registries and gray-literature databases were used to identify unpublished research.

STUDY SELECTION: Two investigators independently selected comparative randomized trials of at least 6 weeks' duration on health outcomes of adult outpatients; nonrandomized studies were eligible for harms.

DATA EXTRACTION: Reviewers abstracted data on study design, participants, interventions, and outcomes; rated the risk of bias; and graded the strength of evidence. A senior reviewer confirmed data and ratings.

DATA SYNTHESIS: 45 trials met inclusion criteria. On the basis of moderate-strength evidence, cognitive behavioral therapy (CBT) and antidepressants led to similar response rates (relative risk [RR], 0.90 [95% CI, 0.76 to 1.07]) and remission rates (RR, 0.98 [CI, 0.73 to 1.32]). In trials, antidepressants had higher risks for adverse events than most other treatment options; no information from nonrandomized studies was available. The evidence was too limited to make firm conclusions about differences in the benefits and harms of antidepressants compared with other treatment options as first-step therapies for acute MDD. For second-step therapies, different switching and augmentation strategies provided similar symptom relief.

LIMITATION: High dropout rates, dosing inequalities, small sample sizes, and poor assessment of adverse events limit confidence in the evidence.

CONCLUSION: Given their similar efficacy, CBT and antidepressants are both viable choices for initial treatment of MDD.

PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality.

Commentaires cliniques (en anglais)

FM/GP/Mental Health

Excellent meta-analysis, showing the strength of CBT as a valid modality, comparable to SGA in effectiveness.

FM/GP/Mental Health

The evidence supporting the similar efficacy of CBT is quite known, but the effect of exercise is always worth reviewing.

General Internal Medicine-Primary Care(US)

There are just too many limitatins in this study to make it worthwhile.


A nice meta-analysis of treatments for major depression by primary care clinicians. The authors point out multiple limitations of their studies, but for what it’s worth, once again cognitive behavioral therapy (CBT) looks as good as antidepressants, and does not cause side effects. A problem with CBT is that it is expensive, time consuming, and not always available.

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