Evidence
This page contains a snapshot of featured content which highlights evidence addressing key clinical questions including areas of uncertainty. Please see the main topic reference list for details of all sources underpinning this topic.
BMJ Best Practice evidence tables
Evidence tables provide easily navigated layers of evidence in the context of specific clinical questions, using GRADE and a BMJ Best Practice Effectiveness rating. Follow the links at the bottom of the table, which go to the related evidence score in the main topic text, providing additional context for the clinical question. Find out more about our evidence tables.
This table is a summary of the analysis reported in a systematic review that focuses on the above important clinical question.
Confidence in the evidence is moderate or low to moderate where GRADE has been performed and there may be no difference in effectiveness between the intervention and comparison for key outcomes.
Population: Adults with major depressive disorder
Intervention: CBT
Comparison: Second-generation antidepressants (e.g., selective serotonin-reuptake inhibitors or serotonin-noradrenaline reuptake inhibitors)
| Outcome | Effectiveness (BMJ rating)? | Confidence in evidence (GRADE)? |
|---|---|---|
Response to treatment | No statistically significant difference | Moderate |
Note The reviewers of the systematic review (view the full source systematic review above) used ‘response to treatment' as defined in the individual studies, but report that most commonly this was presented as a 50% reduction of symptoms on a depression rating scale (e.g., Hamilton Depression Scale).
This evidence table is related to the following section/s:
This table is a summary of the analysis reported in a systematic review that focuses on the above important clinical question.
Confidence in the evidence is very low or low where GRADE has been performed and there may be no difference in effectiveness between the intervention and comparison for key outcomes. However, this is uncertain and new evidence could change this in the future.
Population: Adults with major depressive disorder
Intervention: St John’s Wort
Comparison: Antidepressant
| Outcome | Effectiveness (BMJ rating)? | Confidence in evidence (GRADE)? |
|---|---|---|
Depression, number of treatment responders | No statistically significant difference | Moderate |
Depression scale score | No statistically significant difference | Moderate |
Depression remission | No statistically significant difference | Low |
Depression relapse | No statistically significant difference | Very Low |
Quality of life: mental | No statistically significant difference | Very Low |
Quality of life: physical | Favours intervention | Very Low |
Number of patients with adverse events | Occurs more commonly with antidepressants compared with St John’s Wort (favours intervention) | Moderate |
Serious adverse events | No statistically significant difference | Low |
Gastrointestinal/metabolic/nutritional adverse events | Occurs more commonly with antidepressants compared with St John’s Wort (favours intervention) | Low |
Neurological/nervous system adverse events | Occurs more commonly with antidepressants compared with St John’s Wort (favours intervention) | Low |
Skin/musculoskeletal adverse events | No statistically significant difference | Low |
Respiratory/infectious adverse events | No statistically significant difference | Very Low |
Other organ system (eye, ear, liver, renal, reproductive) adverse events | No statistically significant difference | Low |
Cardiovascular adverse events | No statistically significant difference | Low |
Psychiatric adverse events | Occurs more commonly with antidepressants compared with St John’s Wort (favours intervention) | Very Low |
Sexual dysfunction adverse events | Occurs more commonly with antidepressants compared with St John’s Wort (favours intervention) | Low |
Note The reviewers of the systematic review (view the full source systematic review above) concluded that St John’s Wort is similarly effective when compared with antidepressants. Fewer adverse events occurred in the gastrointestinal, neurological, and psychiatric functioning with St John’s Wort when compared with antidepressants. Only studies with a treatment duration of ≥4 weeks were included.
This evidence table is related to the following section/s:
This table is a summary of the analysis reported in a systematic review that focuses on the above important clinical question.
Confidence in the evidence is very low or low where GRADE has been performed and the intervention may be more effective/beneficial than the comparison for key outcomes. However, this is uncertain and new evidence could change this in the future.
Population: Adults with major depressive disorder
Intervention: St John’s Wort
Comparison: Placebo
| Outcome | Effectiveness (BMJ rating)? | Confidence in evidence (GRADE)? |
|---|---|---|
Depression, number of treatment responders | Favours intervention | Moderate |
Depression scale score | Favours intervention | Moderate |
Depression remission | No statistically significant difference | Low |
Depression relapse | No statistically significant difference | Very Low |
Quality of life: mental | Favours intervention | Low |
Quality of life: physical | No statistically significant difference | Very Low |
Number of patients with adverse events | No statistically significant difference | Moderate |
Serious adverse events | No statistically significant difference | Moderate |
Gastrointestinal/metabolic/nutritional adverse events | No statistically significant difference | Low |
Neurological/nervous system adverse events | Occurs more commonly with St John’s Wort compared with placebo (favours comparison) | Low |
Skin/musculoskeletal adverse events | No statistically significant difference | Very Low |
Photosensitivity | No statistically significant difference | Low |
Respiratory/infectious adverse events | No statistically significant difference | Low |
Other organ system (eye, ear, liver, renal, reproductive) adverse events | Occurs more commonly with St John’s Wort compared with placebo (favours comparison) | Low |
Cardiovascular adverse events | No statistically significant difference | Very Low |
Psychiatric adverse events | No statistically significant difference | Very Low |
Sexual dysfunction adverse events | No statistically significant difference | Very Low |
Note The reviewers of the systematic review (view the full source systematic review above) concluded that St John’s Wort is effective in treating major depressive disorder when compared with placebo. People experienced adverse events related to the nervous system, eye, ear, liver, renal, and reproductive organ systems with St John’s Wort when compared with placebo. Only studies with a treatment duration of ≥4 weeks were included.
This evidence table is related to the following section/s:
Cochrane Clinical Answers
Cochrane Clinical Answers (CCAs) provide a readable, digestible, clinically focused entry point to rigorous research from Cochrane systematic reviews. They are designed to be actionable and to inform decision making at the point of care and have been added to relevant sections of the main Best Practice text.
- How does treatment with antidepressants plus benzodiazepines compare with antidepressants alone for adults with major depression?
- Is there randomized controlled trial evidence to support the use of mirtazapine in people with depression?
- How does behavioral activation therapy compare with cognitive‐behavioral therapy for adults with depression?
- What are the effects of exercise for improving symptoms in adults with depression?
- How do second-generation antipsychotics compare with antidepressants for improving outcomes in people with unipolar major depressive disorder?
- How does brexpiprazole compare with placebo for adults with major depressive disorder?
- What are the effects of psychological therapies for treating depression in older adults living in long‐term care facilities?
- In people with sexual dysfunction induced by antidepressant medication, how do different drugs affect outcomes?
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