The BMJ have published an up to date guideline on the treatment of depression with drugs and physical interventions.  It provides a good overview of the effectiveness and safety of antidepressants, electroconvulsive therapy, exercise, lithium augmentation, pindolol augmentation, and St John’s wort.

The authors found 88 systematic reviews, RCTs, or observational studies and performed a GRADE evaluation of the quality of evidence for interventions.

Here is a summary of the guideline:

• Prescription antidepressant drugs (tricyclic antidepressants [including low-dose tricyclic antidepressants], SSRIs, monoamine oxidase inhibitors, or venlafaxine) versus placebo in mild to moderate or severe depression. New evidence added. Categorisation unchanged (Beneficial).
• Tricyclic antidepressants versus each other and other prescription antidepressant drugs (SSRIs, monoamine oxidase inhibitors, or venlafaxine) in mild to moderate or severe depression. New evidence added. Categorisation unchanged (Beneficial).
• SSRIs versus each other and other prescription antidepressant drugs (tricyclic antidepressants, monoamine oxidase inhibitors, or venlafaxine) in mild to moderate or severe depression. New evidence added. Categorisation unchanged (Beneficial).
• Monoamine oxidase inhibitors versus other prescription antidepressant drugs (tricyclic antidepressant drugs, SSRIs, or venlafaxine) in atypical depressive disorders. New evidence added. Categorisation unchanged (Beneficial).
• Venlafaxine versus other prescription antidepressant drugs (tricyclic antidepressant drugs, SSRIs, or monoamine oxidase inhibitors) in mild to moderate or severe depression. New evidence added. Categorisation unchanged (Beneficial).
• Electroconvulsive therapy in mild to moderate or severe depression. New evidence added. Categorisation unchanged (Beneficial).
• St John’s wort (Hypericum perforatum) in mild to moderate or severe depression. Search updated for an already included systematic review. New evidence added. Categorisation unchanged (Likely to be beneficial).
• Exercise in mild to moderate or severe depression. New evidence added. Categorisation unchanged (Unknown effectiveness), as there remains insufficient evidence to judge the effects of this intervention.
• Augmenting prescription antidepressant drug treatment with lithium in treatment-resistant depression. New evidence added. Categorisation unchanged (Unknown effectiveness), as there remains insufficient evidence to judge the effects of this intervention.
• Continuing prescription antidepressant drug treatment to reduce relapse rates. New evidence added. Categorisation unchanged (Beneficial).

Cipriani A, Barbui C, Butler R, Hatcher S, Geddes J. Depression in adults: drug and physical treatments. Clin Evid (Online). 2011 May 25;2011. [PubMed abstract]