Bibliographic information
Recommendation
In adults with moderate-to-severe depression, psychological interventions or combined treatment should be considered based on individual preferences and careful consideration of the balance of benefits and harms. Antidepressant medicine alone for adults with moderate-to-severe depression should only be considered when psychological interventions are not available. Providers should keep in mind the possible adverse effects associated with antidepressant medicines, and individual preferences.
Recommended in favor
Conditional
Certainty of evidence
Low
Notes and Remarks
Remarks y The term “combined treatment” refers to psychological interventions provided together with antidepressant medicines. y Psychological interventions include BAT, DYN, CBT, IPT, PST and 3WV. The review focused on psychological interventions delivered by mental health professionals. y Antidepressants include SSRIs (e.g. citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine or sertraline) and TCAs (e.g. amitriptyline and clomipramine).
Implementation considerations y Face-to-face psychological interventions delivered by service providers are human resource-intensive as they require substantial provider time, training and supervision. y Both generic TCAs and many generic SSRIs are associated with low acquisition costs. y Discontinuities in drug availability (common in LMICs) may interfere with continuation of treatment. y Service providers should help the person make decisions about available treatments, based on providing relevant information (e.g. possible side-effects, costs). y A stepped care treatment approach may be considered offering psychological interventions first. If the person does not improve with psychological interventions, combined treatment can be considered based on individual preferences and careful consideration of the balance of benefits and harms.