Therapy plus antidepressants improved outcomes in patients with severe, nonchronic depression

Data from a recent study suggest that cognitive therapy combined with antidepressant medication led to better rates of recovery among patients with severe, nonchronic depression compared with antidepressant medication alone.

Steven D. Hollon, PhD, of Vanderbilt University, and colleagues evaluated 452 adult outpatients with chronic or recurrent major depressive disorder (MDD) to compare the effect of antidepressant medication with cognitive therapy (n=227) vs. antidepressants alone (n=225).

Overall, remission rates were high among both groups, however time to remission was shorter in the antidepressant plus cognitive therapy group compared with the antidepressant-only group, though this was not significant. Similarly, although not significant, the combination therapy group showed fewer relapses compared with the antidepressant-only group.

The antidepressant plus cognitive therapy group experienced better recovery rates compared with the antidepressant-only group (HR=1.33; 95% CI, 1.06-1.68). Participants without comorbid Axis II disorders irrespective of treatment conditions also had higher recovery rates compared with those with the disorders (HR=1.40; 95% CI, 1.11-1.77).

Among participants with low-severity MDD, both treatment groups had similar recovery rates. However, among participants with high-severity MDD, those in the combination therapy group had better recovery rates (HR=1.71; 95% CI, 1.24-2.37). Similarly, among participants with non-chronic MDD, those in the combination group had better recovery rates (HR=1.69; 95% CI, 1.26-2.27). Significant differences were not found between the two groups among participants with chronic MDD.

“Cognitive therapy combined with medication treatment enhanced rates of recovery relative to medications alone, with the effect limited to patients with severe non-chronic depressions,” the researchers wrote. “Combined treatment also reduced the frequency of severe adverse events, but largely because it reduced time in episode.”

In a related editorial, Michael E. Thase, MD, of the University of Pennsylvania in Philadelphia, wrote that the findings support combined treatment for MDD.

“Specifically, combined treatment was more effective for patients with higher symptom levels and less effective for those with more chronic episodes…By contrast combined treatment provided no advantage over pharmacotherapy alone for the subsets of patients with milder depressions and with more chronic depressions, who did as well with pharmacotherapy alone,” he wrote.

For more information:

Hollon SD. JAMA Psychiatry. 2014;doi:10.1001/jamapsychiatry.2014.1054.

Thase ME. JAMA Psychiatry. 2014;doi:10.1001/jamapsychiatry.2014.1524.

Disclosure: See the full studies for a complete list of the researchers’ relevant financial disclosures.