Adding Psychotherapy to Pharmacotherapy in the Treatment of Depressive Disorders in Adults

Abstract

Objective: A considerable number of studies has examined whether adding psychotherapy to pharmacotherapy results in stronger effects than pharmacotherapy alone. However, earlier metaanalyses in this field have included only a limited number of available studies and did not conduct extended subgroup analyses to examine possible sources of heterogeneity.Data Sources: We used a database derived from a comprehensive literature search in PubMed, PsycINFO, EMBASE, and the Cochrane Central Register of Controlled Trials for studies published from 1966 to January 2008 that examined the psychological treatment of depression. The abstracts of these studies were identified by combining terms indicative of psychological treatment and depression.Study Selection: We included randomized trials in which the effects of a pharmacologic treatment were compared to the effects of a combined pharmacologic and psychological treatment in adults with a depressive disorder.Data Extraction: For each of the studies, we calculated a standardized mean effect size indicating the difference between pharmacotherapy and the combined treatment at posttest. We also coded major characteristics of the population, the interventions, and the quality and design of the study.Data Synthesis: Twenty-five randomized trials, with a total of 2,036 patients, were included. A mean effect size of d = 0.31 (95% CI, 0.20 ~ 0.43) was found for the 25 included studies, indicating a small effect in favor of the combined treatment over pharmacotherapy alone. Studies aimed at patients with dysthymia resulted in significantly lower effect sizes compared to studies aimed at patients with major depression, a finding that suggests that the added value of psychotherapy is less in patients with dysthymia. The dropout rate was significantly lower in the combined treatment group compared to the pharmacotherapy only group (OR = 0.65; 95% CI, 0.50 ~ 0.83).Conclusions: Psychotherapy seems to have an additional value compared to pharmacotherapy alone for depression. for depression in adults have been examined in a considerable number of studies. The combination of the 2 treatments has been less well-examined, however. A growing body of evidence that combined treatment is more effective than psychotherapy alone [3][4][5] suggests that adding pharmacotherapy has an independent, cumulative effect on depression. Research is less conclusive, however, on the question of whether combined treatment is more effective than pharmacotherapy alone. Some studies do find support for this, 6-8 but others do not. [9][10][11] Because it can be expected that the difference between psychological and combined treatments is small, large sample sizes are required to find significant differences. When small effect sizes are expected in individual studies, meta-analytic techniques can be used to integrate the results of individual studies and to increase the statistical power. 12Although 2 earlier meta-analytic studies 4,13 have examined the difference between pharmacologic and combined treatments, these ...

Usual Primary Care Provider Characteristics of a Patient-Centered Medical Home and Mental Health Service Use

“…This is an important distinction, as the addition of counseling to pharmacotherapy treatment, especially for racial/ethnic minorities, is sometimes more effective in treating mental health disorders than pharmacotherapy alone. [54][55][56] Because counseling is often recommended in combination with pharmacotherapy for patients with severe disorders, 57,58 our findings suggest the PCMH may enhance the quality of mental healthcare for those in need. Indeed, our finding that patients with a PCMH rated their healthcare better than patients with a usual provider only offers preliminary evidence of a quality benefit associated with the PCMH.…”

Adding Psychotherapy to Antidepressant Medication in Depression and Anxiety Disorders: a Meta-Analysis

“…Effective treatments are available for these disorders, including several types of psychotherapy and antidepressant medication (9)(10)(11). Although psychotherapy and antidepressants are about equally effective for most anxiety and depressive disorders (12), there is some evidence that combined treatments may be more effective than each of these treatment alone (13)(14)(15). At the same time, however, an increasing proportion of patients with mental disorders in the past decade have received psychotropic medication without psychotherapy (16,17).…”

“…Although some earlier meta-analyses have examined this question, these were all aimed at one disorder, especially depression (13)(14)(15) and panic (18,19). For some other disorders -e.g., social anxiety disorder (SAD) and obsessive-compulsive disorder (OCD) -several primary studies have been conducted, but these have not yet been integrated into meta-analyses.…”

"Depresión": Imprecisión diagnóstica y terapéutica. Importantes consecuencias en la práctica clínica

“…En cuanto a técnicas psicoterapéuticas más complejas y estructuradas, algunas de ellas han mostrado una significativa eficacia en el abordaje de la "depresión", incluso en la depresión mayor, tanto para el tratamiento de los episodios agudos como en la prevención de recaídas (88)(89)(90)(91)(92), Sin embargo, estas técnicas psicoterapéuticas no se han incorporado, como sería deseable, en la práctica clínica especializada de la sanidad pública española, y salvo en escasísimos dispositivos asistenciales, no forman parte de la oferta terapéutica para el tratamiento de los trastornos depresivos.…”