Effectiveness of Antidepressants vs CBT for Adult Depression Review

This integrated literature review systematically examines the effectiveness of antidepressants compared to Cognitive Behavioral Therapy (CBT) in treating depression in adults. It addresses the background of depression as a significant health problem, particularly in older adults, and explores the challenges associated with long-term antidepressant use due to side effects. The review aims to determine if CBT is a more effective alternative. The inclusion criteria focus on studies with adult participants experiencing depression, interventions involving antidepressants, comparisons with CBT, outcomes related to depression symptom management, and various study designs published between 2008 and 2018. The search methods involve electronic databases like Medline, CINAHL, and PubMed via the EBSCO interface, utilizing keywords such as 'antidepressants,' 'CBT,' and 'depression' with Boolean operators. The review process includes screening by two reviewers, quality assessment using the Cochrane Risk of Bias Assessment tool, and data extraction focusing on key study elements. Meta-analysis is not conducted due to potential inconsistencies in treatment effects across studies.

This template is intended to help you plan your integrated literature review in a systematic way.
TITLE OF THE REVIEW Effectiveness of antidepressants compared to CBT in treating adults with dementia
STUDENT
SUPERVISOR
BACKGROUND TO REVIEW Depression is a familiar and significant health problem that mostly
observed in older adults. According to world health organization, the
depression can be the result of the genetic, psychological, physical
and environmental factors that disrupt the stability of the lifestyle of
individuals (Linde et al., 2015). There are various treatment modes
are available to manage the depression in individuals. However, due
to the nature of the diseases, most of the patient suggested
continuing long-term treatment for effectively managing the disease
(Chandroth & Abraham,2015). This can be a challenge to the
clinicians and patients to continue any long-term treatment.
Approximately, 350 billion people of different age group are
depressed and women are more depressed compared to men which
further leads to the adverse consequences (Kuyken et al., 2015). A
person with depression usually lacks the prime interest in doing any
daily activities and it affected the overall performance of a
depressed person. Low self-esteem is proved to be one of the major
risk factors in the development of the disease. Cognitive behavioral
therapy is the most common psychological therapy that manages
depression in individuals (Williams et al., 2016). Unfortunately, due
to lack of sound knowledge about the different psychological
therapies, most of the physicians suggest the antidepressant for
managing the depression in adults. The antidepressant is an

effective short-term treatment with the side effects such as nausea,
dry mouth and blurred vision (Cipriani et al., 2018). Therefore, the
aim of the study is finding out whether the cognitive behavioral
therapy is more effective than antidepressant or not.
RESEARCH QUESTION (PICO Format)
SPECIFIC AIM IN ADULTS WITH DEPRESSION ARE ANTIDEPRESANTS EFFECTIVE IN THE
MANAGEMENT OF DEPRESSION SYMPTOMS AS COMPARED TO
COGNITIVE BEHAVIORAL THERAPY (CBT)
OBJECTIVES The depression is highly prevalent disorder in the general adult
population in worldwide (Hill, Sahay & Hen, 2015). The population
wide administration of psychological therapies is difficult because of
the number of qualified therapies. Therefore, the aim of the study is
to found out the whether the antidepressants effective in the
management of depression symptoms as compared to cognitive
behavioural therapy (cbt).
CRITERIA FOR INCLUDING STUDIES IN
THE REVIEW
Inclusion criteria in a systematic review are a set of conditions that clarifies what type
of studies can be taken and what should be excluded from a systematic review. The
criteria ensure that relevant studies are included and no study is avoided without
proper evaluation (Gough, Oliver & Thomas, 2017). To conduct systematic review of

 Population/Participants
 Interventions/Exposures
 Comparisons/Control Group/s
 Outcomes Of Interest
 Setting
 Study Designs To Be Included
research literature related to the research, the criteria for including studies in the
review will be as follows:
Population/participants: Research paper which has adults with depression or major
depressive disorder as the sample group will be included in research. Other sample
groups will be excluded.
Intervention/exposure: Antidepressants should be the main exposure or intervention
of interest for selected studies. This is important to understand the role of anti-
depressant in treating depression. This criteria is vital to achieve the aim and
objectives of the review.
Comparison/control groups: Only those research articles will be taken which has CBT
as the comparator or which compared the efficacy of antidepressants by comparing it
with CBT.
Outcome of interest: As main outcome that needs to be evaluated through the
systematic review includes management of depression, only those research papers
will be taken that reports about outcomes such as reduction in depressive symptoms
or control in the depressive symptoms.
Setting: Research articles which have conducted studies in either clinical setting or
home based setting or community setting will be included in research.
Study designs to be included: As the main purpose of the systematic review is to gain
an understanding regarding the efficacy of antidepressants compared to CBT in the
management of depression, studies with all types of research papers will be included
in the review. There is no restriction regarding the research design.
Other inclusion criteria include publication date and studies published between 2008
to 2018 will be included in the review.
By screening research articles in terms of the above inclusion criteria, it will increase

the likelihood of choosing suitable articles for the review.
SEARCH METHODS
 Electronic Databases
o please list all databases that
are to be searched and
include the interface (eg nhs,
ebsco, etc) and date ranges
searched for each
 Other Methods Used For Identifying
Relevant Research
o ie contacting experts and
reference checking
 Journals Hand Searched
o if any are to be hand
searched, please list which
journals and date searched
from, including a rationale
Electronic databases:
To get answers to the research question, articles for the review will be selected from
those databases that publish biomedical research literatures, nursing and allied health
research. Medline, CINAHL and PubMed are some database that publishes articles
from the above mentioned field. From wide range of interfaces, EBSCO will be used
as an interface as it is reliable source that provides access to wide range of databases
and peer reviewed content to students and researchers. It has highest quality academic
research database and it supports users to quickly access the content using ‘one-click
linking to full test’ option and ‘single sign-on authentication’. Hence, choosing will
EBSCO will save time and enhance access to high quality research database and e-
journals.
For each of the three mentioned databases, search filter will be applied for publication
date. The date that will be chosen for the article search is 2008 to 2018. This will
ensure review and evaluation of only those research literatures that has been published
within the past 10 years.
Selecting databases and adapting publication are part of the search strategy. The
search strategy is defined as the strategy that used for extracting a
specific plan of the research from the literature. In order to obtain
accurate secondary data, developing search strategy is important
(Lewis, 2015). Search strategy is an important route map that
increases the chance of finding the most relevant research
literature. The next important phase after selection of database is to
explore various keywords and develop important keywords that can
be used during the search process. Relevant keywords will be

identified by reviewing research question and finding out the
synonyms for specific keywords. For example, for this review, the
main keywords that will be used are antidepressants, CBT,
depression, effectiveness, reducing depression and adults with
depression. The search strategy will be widened by using thesaurus
to identify similar keywords. For antidepressant
medications/antidepressant therapy, antidepressant drugs and
efficacy/effectiveness.
In addition, as research database has advanced search filters,
Boolean operators like ‘AND’ and ‘OR’ will also be used to search for
literature in CINAHL. The main advantage of using Boolean operators
is that it increases the chance of getting the most relevant papers
(Aromataris & Riitano, 2014). The table below shows how search terms
and Boolean operators can be combined to obtain relevant research
articles. This strategy will help to get large number of hits after
entering search terms in different research literature.
Antidepressants
AND
CBT AND
Prevention
OR
Control
OR
Reduce
Depression
OR
Depressive
symptoms
Antidepressant
medication
AND
CBT therapy
Pharmacology
AND
CBT therapy

Other methods for identifying relevant research:
Other strategies that will be used to find relevant research papers include checking the
reference list of papers and selecting other suitable research literatures from the list.
Experts from the field of health care and mental health will also be contacted to get an
idea about relevant research papers that gives the best evidence on the topic. No hand
searching of research papers will be used as it a time-consuming process and only two
or three papers can be evaluated using hand search method.
METHODS OF REVIEW
Details Of Methods
 Number Of Reviewers, How
Agreements To Be Reached And
Disagreements Dealt With, etc
 Quality Assessment Tools Or
Checklists Used With
References Or Urls
Data Extraction
 what information is to be collected
on each included study. if
databases or forms on word or
excel are used and how this is
recorded narrative synthesis
 details of what and how synthesis
will be done
Meta-Analysis
Details of methods:
The inclusion criteria will be the main elements that will be used as a framework to
review and screen research evidence for suitability and selection in the review. As
disagreement may arise during the process of screening research articles, the screening
process will be done by recruiting two reviewers. The main rationale for selecting two
reviewers is to achieve consensus regarding the suitability of research articles as per
inclusion criteria and reducing the possibility of selection bias during the search
process. The reviewers will conduct screening by reviewing title and abstract of the
papers first. This will help to understand whether the paper is relevant or not.
Furthermore, to improve the specificity of the search process, the research articles will
be scrutinized as per the inclusion criteria. Any kind of disagreements between
reviewers will also be resolved by reviewing full text of the papers and finding out any
flaws in research design that would affect the validity of the studies. Overall, the final
paper selection will occur only when all disagreements are solved and consensus is
achieved from both the reviewers.
After selecting suitable research paper, quality assessment will be an important
component of the review. Conducting quality assessment by use of rigorous data
analysis method and use of evidence based quality assessment tool is important to
understand the credibility and reliability of research findings (Carroll & Booth, 2015).
For this particular review, it has been planned to evaluate research rigor and biases in
research findings by the use of Cochrane Risk of Bias Assessment tool. The main

 details of what and how analysis
and testing will be done. if no meta-
analysis is to be conducted, please
give reason.
rational for selecting this tool for quality assessment is that it will help to identify bias
in research and comment on the quality of research process. According to Pannucci
and Wilkins (2010), critically evaluating rigor of study design and identifying biases is
important in evidence based practice to critically interpret results. Bias occurs because
of unprejudiced consideration of a question and presence of bias influence identifying
true association between research outcomes. Hence, identifying bias and confounding
factor is important. Hence, in accordance with this requirement, the Cochrane risk of
Bias Assessment tool will be used as it will support identification of different types of
bias in research design like selection bias, reporting bias, attrition bias and
performance bias. It helps in the identification of bias in different domains like
random sequence generation, allocation concealment, blinding and selective reporting
(Cochrane Methods, 2018). Hence, the quality of the evidence will be judged by
categorizing evidence into low or high quality of evidence. The Quality assessment
table will be given in the result section.
Data Extraction:
Data extraction is an important part of the systematic review process as significantly
influence review findings by shaping the range of data that will be feed into the
synthesis. The key items of data extraction should be specified in advance as it can
help to conduct the review in a more iterative process. Review authors can
accordingly read and analyzed the paper, extract data and engage in synthesis in
several cycles. For this systematic review, the following items will be extracted and
presented in the data extraction table:
 Author and date
 Research aim
 Study population
 Research setting
 Research method
 Study findings
 Significance of the study
The data extraction table can help to get an overview of the paper and understand the
main findings that will emerge from different research papers.

Data analysis:
Meta-analysis will not be done for this review as it is done when treatment effect is
consistent in all studies and the main purpose is to identify common effect. However,
as identifying the treatment effect and different types of outcome obtained is the main
focus of this systematic review, thematic analysis will be used to compare and
analyzed the effect of two interventions. The main rational for choosing thematic
analysis method is that it can help to identify common themes in research and
categorize research evidence accordingly. It is a suitable method for quality analysis
of research studies and the exhaustive manner of analysis will increase the
trustworthiness of research (Braun, Clarke & Terry, 2014).
Presentation Of Results
 additional material
 summary tables, flowcharts, etc, to
be included in the final paper
 outputs from review
 papers and target journals,
conference presentations, reports,
etc
The result section will initiate by a brief discussion on the search results, screening
process and the final articles obtained. The systematic process of identification,
screening and elgibility of the research papers will be summarized in the form of
PRISMA flow chart. The flow chart has been given in appendix 1.
After all the relevant papers are analyzed, the qualitative assessment results will be
provided in the format below:
Reference
s
Sequence
generation
Allocation
concealment
Blinding of
participants
Blinding
of
outcome
assessor
Incomplete
Outcome
date
Other
source
of
bias
Author et
al. year
+ + ? - + -
+ sign will indicate high risk of bias, - means low risk of bias and question mark
suggest unclear risk of bias.
7. Timeline For Review – When do you
aim to complete each stage of the
It is expected to complete the research within six months period. The timeline for

review
 Literature Searching
 Quality Appraisal
 Data Extraction
 Synthesis
 Writing Up
each stage are as follows:
Stages of
systematic
review
Oct
2018
Nov
2018
Dec 2018 Jan 2019 Feb 2019 March
2019
Literature
searching
Quality
appraisal
Data
extraction
Synthesis
Writing up
References:
Aromataris, E., & Riitano, D. (2014). Systematic reviews: constructing a search strategy and searching for evidence. AJN The
American Journal of Nursing, 114(5), 49-56.
Braun, V., Clarke, V., & Terry, G. (2014). Thematic analysis. Qual Res Clin Health Psychol, 24, 95-114.
Carroll, C., & Booth, A. (2015). Quality assessment of qualitative evidence for systematic review and synthesis: Is it meaningful, and
if so, how should it be performed?. Research Synthesis Methods, 6(2), 149-154.
Cipriani, A., Furukawa, T. A., Salanti, G., Chaimani, A., Atkinson, L. Z., Ogawa, Y., ... & Egger, M. (2018).
Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults
with major depressive disorder: a systematic review and network meta-analysis. The
Lancet, 391(10128), 1357-1366.
Cipriani, A., Furukawa, T. A., Salanti, G., Chaimani, A., Atkinson, L. Z., Ogawa, Y., ... & Egger, M. (2018).
Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults

with major depressive disorder: a systematic review and network meta-analysis. The
Lancet, 391(10128), 1357-1366.
Cochrane Methods (2018). Assessing Risk of Bias in Included Studies. Retrieved from: http://methods.cochrane.org/bias/assessing-
risk-bias-included-studies
Gough, D., Oliver, S., & Thomas, J. (Eds.). (2017). An introduction to systematic reviews. Sage.
Hill, A. S., Sahay, A., & Hen, R. (2015). Increasing adult hippocampal neurogenesis is sufficient to reduce
anxiety and depression-like behaviors. Neuropsychopharmacology, 40(10), 2368.
Kuyken, W., Hayes, R., Barrett, B., Byng, R., Dalgleish, T., Kessler, D., ... & Causley, A. (2015). Effectiveness
and cost-effectiveness of mindfulness-based cognitive therapy compared with maintenance
antidepressant treatment in the prevention of depressive relapse or recurrence (PREVENT): a
randomised controlled trial. The Lancet, 386(9988), 63-73.
Lewis, S. (2015). Qualitative inquiry and research design: Choosing among five approaches. Health
promotion practice, 16(4), 473-475.
Linde, K., Sigterman, K., Kriston, L., Rücker, G., Jamil, S., Meissner, K., & Schneider, A. (2015). Effectiveness
of psychological treatments for depressive disorders in primary care: systematic review and meta-
analysis. The Annals of Family Medicine, 13(1), 56-68.
Nowell, L. S., Norris, J. M., White, D. E., & Moules, N. J. (2017). Thematic analysis: Striving to meet the trustworthiness
criteria. International Journal of Qualitative Methods, 16(1), 1609406917733847.
Pannucci, C. J., & Wilkins, E. G. (2010). Identifying and Avoiding Bias in Research. Plastic and Reconstructive Surgery, 126(2),
619–625. http://doi.org/10.1097/PRS.0b013e3181de24bc
Williams, L. M., Debattista, C., Duchemin, A. M., Schatzberg, A. F., & Nemeroff, C. B. (2016). Childhood
trauma predicts antidepressant response in adults with major depression: data from the randomized

international study to predict optimized treatment for depression. Translational psychiatry, 6(5),
e799.

Appendix:
1. Prisma flowchart for systematic review: