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ACP publishes depression recommendations; news from Annals of Internal Medicine

Annals of Internal Medicine Tip Sheet

American College of Physicians

1. ACP recommends either cognitive behavioral therapy or antidepressants for treating major depressive disorder
Evidence suggests that both treatments are similarly effective in adults with depression
Free reco: http://www.annals.org/article.aspx?doi=10.7326/M15-2570
Free review: http://www.annals.org/article.aspx?doi=10.7326/M15-1813
Free editorial: http://www.annals.org/article.aspx?doi=10.7326/M16-0104
URLs live when the embargo lifts

In a new clinical practice guideline published in Annals of Internal Medicine, the American College of Physicians (ACP) recommends that physicians select either cognitive behavioral therapy or second generation antidepressants to treat adults with major depressive disorder (MDD). A review of the evidence finds that both are similarly effective for treating depression. Physicians should base their decision on a discussion with the patient about treatment effects, adverse effect profiles, cost, accessibility, and preferences.

MDD is a medical condition causing sadness that interferes with daily life, not a normal reaction to life situations such as the death of a loved one or the loss of a job. Common MDD symptoms are lack of energy and loss of interest in things previously enjoyed. ACP developed its guideline to summarize and grade the evidence on the comparative effectiveness and safety of non-drug treatments and second generation antidepressants (SSRIs, SNRIs, bupropion, mirtazapine, nefazodone, trazodone), alone or in combination, for treating MDD in adults.

Moderate-quality evidence showed that cognitive behavioral therapy and newer antidepressants are similarly effective treatments for MDD and that discontinuation rates are similar for both. Low-quality evidence showed no difference in effectiveness or adverse effects between first line treatment using antidepressants compared to non-drug treatments (complementary and alternative medicines, or exercise monotherapies or combination therapies).

Low-quality evidence showed that St John's wort may be as effective as second generation antidepressants for treating depression, and moderate-quality evidence showed that St John's wort was better tolerated than antidepressants. However, St. John's wort is not currently regulated by the Food and Drug Administration in the U.S. and no standard is in place regarding the contents and potency of the medication.

Note: For an embargoed PDF, please contact Cara Graeff. To interview someone from ACP, please contact Steve Majewski at smajewski@acponline.org or 215-351-2514.


2. More evidence that "metabolically healthy obesity" is not a harmless condition
Being overweight or obese, even without metabolic abnormalities, increases risk for chronic kidney disease
Abstract: http://www.annals.org/article.aspx?doi=10.7326/M15-1323
URL goes live when the embargo lifts

According to a study published in Annals of Internal Medicine, patients who are overweight or obese, even in the absence of metabolic abnormalities, are at increased risk for chronic kidney disease (CKD). These results offer more evidence that "metabolically healthy obesity" is not a harmless condition.

CKD is a precursor for end-stage renal disease and a strong risk factor for cardiovascular morbidity and mortality. Its prevalence is increasing worldwide along with the growing prevalence of obesity and metabolic disease. While obesity with associated metabolic risk factors (hypertension, insulin resistance, hyperglycemia, dyslipidemia) has been identified as a major risk factor for CKD, whether there is a link between metabolically healthy obesity (being obese without associated metabolic abnormalities) and CKD is not known.

Researchers studied a large cohort of young to middle-aged South Korean men and women who were metabolically healthy and without CKD or proteinuria to assess the risk for CKD for patients in various body mass index (BMI) categories. The researchers found that being overweight or obese was associated with increased CKD incidence. These findings show that metabolically healthy obesity is not a harmless condition and that being overweight, regardless of metabolic abnormalities, can adversely affect renal function.

Note: For an embargoed PDF, please contact Cara Graeff. To interview the lead author, Dr. Eliseo Guallar, please contact Stephanie Desmon at sdesmon1@jhu.edu or 410-955-7619.


3. USPSTF recommends screening for major depressive disorder in adolescents ages 12 to 18
Free content: http://www.annals.org/article.aspx?doi=10.7326/M15-2957
Free revew: http://www.annals.org/article.aspx?doi=10.7326/M15-2259
URL goes live when the embargo lifts

The U.S. Preventive Services Task Force recommends screening for major depressive disorder (MDD) in children and adolescents, stating that adolescents ages 12 to 18 should be screened for MDD when adequate systems are in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up. The recommendation is simultaneously published in Annals of Internal Medicine and Pediatrics.

MDD is a serious form of depression. People with depression feel down and experience a lack of interest in normal activities--and with MDD, these feelings last more than 2 weeks. Depression can make it difficult for adolescents to function, relate, and develop, which can affect their performance at school or work and their interactions with family and peers. By screening for depression and identifying young people with MDD, support and treatment can be put in place to alleviate symptoms and lessen the risk of suicide.

The Task Force found that adolescents ages 12 to 18 who were screened and identified in primary care as having MDD, and provided treatment, experienced improved depression symptoms and daily functioning. However, the Task Force found that there was not enough evidence to assess the benefits and harms of screening for MDD in children younger than 12.

Note: The URLs, including video link, will be live when the embargo lifts. For an embargoed PDF, please contact Cara Graeff. To interview a member of the Task Force, please contact the USPSTF media coordinator at newsroom@USPSTF.net or 202-572-2044.

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Original Research
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Treatment of Meniscal Tear: The More We Learn, the Less We Know
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Speak Up! Addressing the Paradox Plaguing Patient-Centered Care
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