Combination of Pharmacotherapy and Psychotherapy in the Treatment of Chronic Depression: a Systematic Review and Meta-analysis

Overview

Journal BMC Psychiatry

Publisher Biomed Central

Specialty Psychiatry

Date 2012 Jun 15

PMID 22694751

Citations 20

Authors

Alessa von Wolff

Lars P Holzel

Annika Westphal

Martin Harter

Levente Kriston

Affiliations

Soon will be listed here.

Abstract

Background: Chronic depression represents a substantial portion of depressive disorders and is associated with severe consequences. This review examined whether the combination of pharmacological treatments and psychotherapy is associated with higher effectiveness than pharmacotherapy alone via meta-analysis; and identified possible treatment effect modifiers via meta-regression-analysis.

Methods: A systematic search was conducted in the following databases: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, ISI Web of Science, BIOSIS, PsycINFO, and CINAHL. Primary efficacy outcome was a response to treatment; primary acceptance outcome was dropping out of the study. Only randomized controlled trials were considered.

Results: We identified 8 studies with a total of 9 relevant comparisons. Our analysis revealed small, but statistically not significant effects of combined therapies on outcomes directly related to depression (BR = 1.20) with substantial heterogeneity between studies (I² = 67%). Three treatment effect modifiers were identified: target disorders, the type of psychotherapy and the type of pharmacotherapy. Small but statistically significant effects of combined therapies on quality of life (SMD = 0.18) were revealed. No differences in acceptance rates and the long-term effects between combined treatments and pure pharmacological interventions were observed.

Conclusions: This systematic review could not provide clear evidence for the combination of pharmacotherapy and psychotherapy. However, due to the small amount of primary studies further research is needed for a conclusive decision.

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References

Schramm E, Schneider D, Zobel I, van Calker D, Dykierek P, Kech S . Efficacy of Interpersonal Psychotherapy plus pharmacotherapy in chronically depressed inpatients. J Affect Disord. 2007; 109(1-2):65-73. DOI: 10.1016/j.jad.2007.10.013. View

Torpey D, Klein D . Chronic depression: update on classification and treatment. Curr Psychiatry Rep. 2008; 10(6):458-64. DOI: 10.1007/s11920-008-0074-6. View

Gilmer W, Trivedi M, Rush A, Wisniewski S, Luther J, Howland R . Factors associated with chronic depressive episodes: a preliminary report from the STAR-D project. Acta Psychiatr Scand. 2005; 112(6):425-33. DOI: 10.1111/j.1600-0447.2005.00633.x. View

Song F, Altman D, Glenny A, Deeks J . Validity of indirect comparison for estimating efficacy of competing interventions: empirical evidence from published meta-analyses. BMJ. 2003; 326(7387):472. PMC: 150178. DOI: 10.1136/bmj.326.7387.472. View

Wolf N, Hopko D . Psychosocial and pharmacological interventions for depressed adults in primary care: a critical review. Clin Psychol Rev. 2007; 28(1):131-161. DOI: 10.1016/j.cpr.2007.04.004. View

Markowitz J, Kocsis J, Bleiberg K, Christos P, Sacks M . A comparative trial of psychotherapy and pharmacotherapy for "pure" dysthymic patients. J Affect Disord. 2005; 89(1-3):167-75. DOI: 10.1016/j.jad.2005.10.001. View

Browne G, Steiner M, Roberts J, Gafni A, Byrne C, Dunn E . Sertraline and/or interpersonal psychotherapy for patients with dysthymic disorder in primary care: 6-month comparison with longitudinal 2-year follow-up of effectiveness and costs. J Affect Disord. 2002; 68(2-3):317-30. DOI: 10.1016/s0165-0327(01)00343-3. View

Kocsis J . Pharmacotherapy for chronic depression. J Clin Psychol. 2003; 59(8):885-92. DOI: 10.1002/jclp.10180. View

Lima M, Moncrieff J . Drugs versus placebo for dysthymia. Cochrane Database Syst Rev. 2000; (4):CD001130. DOI: 10.1002/14651858.CD001130. View

10.

Barrett B, Byford S, Knapp M . Evidence of cost-effective treatments for depression: a systematic review. J Affect Disord. 2004; 84(1):1-13. DOI: 10.1016/j.jad.2004.10.003. View

11.

Berndt E, Koran L, Finkelstein S, Gelenberg A, Kornstein S, Miller I . Lost human capital from early-onset chronic depression. Am J Psychiatry. 2000; 157(6):940-7. DOI: 10.1176/appi.ajp.157.6.940. View

12.

Satyanarayana S, Enns M, Cox B, Sareen J . Prevalence and correlates of chronic depression in the canadian community health survey: mental health and well-being. Can J Psychiatry. 2009; 54(6):389-98. DOI: 10.1177/070674370905400606. View

13.

Michalak E, Lam R . Breaking the myths: new treatment approaches for chronic depression. Can J Psychiatry. 2002; 47(7):635-43. DOI: 10.1177/070674370204700705. View

14.

DerSimonian R, Laird N . Meta-analysis in clinical trials. Control Clin Trials. 1986; 7(3):177-88. DOI: 10.1016/0197-2456(86)90046-2. View

15.

Kocsis J, Gelenberg A, Rothbaum B, Klein D, Trivedi M, Manber R . Cognitive behavioral analysis system of psychotherapy and brief supportive psychotherapy for augmentation of antidepressant nonresponse in chronic depression: the REVAMP Trial. Arch Gen Psychiatry. 2009; 66(11):1178-88. PMC: 3512199. DOI: 10.1001/archgenpsychiatry.2009.144. View

16.

Moher D, Liberati A, Tetzlaff J, Altman D . Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009; 151(4):264-9, W64. DOI: 10.7326/0003-4819-151-4-200908180-00135. View

17.

Cuijpers P, van Straten A, Schuurmans J, van Oppen P, Hollon S, Andersson G . Psychotherapy for chronic major depression and dysthymia: a meta-analysis. Clin Psychol Rev. 2009; 30(1):51-62. DOI: 10.1016/j.cpr.2009.09.003. View

18.

Mohr D, Hart S, Howard I, Julian L, Vella L, Catledge C . Barriers to psychotherapy among depressed and nondepressed primary care patients. Ann Behav Med. 2006; 32(3):254-8. DOI: 10.1207/s15324796abm3203_12. View

19.

Bucher H, Guyatt G, Griffith L, Walter S . The results of direct and indirect treatment comparisons in meta-analysis of randomized controlled trials. J Clin Epidemiol. 1997; 50(6):683-91. DOI: 10.1016/s0895-4356(97)00049-8. View

20.

Kriston L, von Wolff A, Holzel L . Effectiveness of psychotherapeutic, pharmacological, and combined treatments for chronic depression: a systematic review (METACHRON). BMC Psychiatry. 2010; 10:95. PMC: 3002317. DOI: 10.1186/1471-244X-10-95. View