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Integration of pharmacotherapy, psychotherapy effective for relapse in MDD

Results from a meta-analysis of randomized controlled trials indicate the sequential integration of cognitive behavioral therapy and pharmacotherapy is a worthwhile strategy for preventing relapse in major depressive disorder.

“In the early nineties, the presence of residual symptoms despite successful response to drug or psychotherapeutic treatment in mood disorders became manifest. Its correlation with poor long-term outcome led to the hypothesis that residual symptoms upon recovery might progress to become prodromal symptoms of relapse and that treatment directed toward residual symptoms might yield long-term benefits,” Jenny Guidi, PhD, of University of Bologna, Italy, and colleagues wrote.

To review efficacy of sequential integration of pharmacotherapy and psychotherapy for major depressive disorder (MDD), researchers conducted a meta-analysis of 13 randomized controlled trials including 728 patients receiving sequential treatment and 682 receiving control treatment. Included studies examined the efficacy of administering psychotherapy after successful response to acute-phase pharmacotherapy among adults with MDD. All studies included cognitive behavioral therapy (CBT).

The pooled risk ratio for relapse/recurrence was 0.781 (95% CI, 0.671-0.909), according to the random-effects model. This suggested sequential integration of pharmacotherapy and psychotherapy had relative advantage in preventing relapse/recurrence compared with control conditions, the researchers reported.

Analysis indicated CBT had a significant effect during continuation of antidepressants compared with antidepressants alone or treatment as usual (risk ratio = 0.811; 95% CI, 0.685-0.961).

Individuals randomly assigned to CBT who had antidepressants tapered and discontinued were significantly less likely to experience relapse or recurrence compared with those assigned to clinical management or continuation of antidepressant medication (risk ratio = 0.674; 95% CI, 0.482-0.943).

“The selection of treatment in depression may ultimately depend on the use of biomarkers and neuroimaging. In the [meantime], however, consideration of a number of clinical variables, such as characteristics and severity of depressive episode, co-occurring symptomatology and residual symptoms, medical comorbidities, and the patient’s history with particular reference to treatment of previous episodes, if they occurred, provides important indications for the application of the psychotherapeutic strategies to the management of the depressed patient,” Guidi and colleagues wrote. “The sequential modality of integration of pharmacotherapy and psychotherapy appears to be a valuable therapeutic strategy for preventing relapse.” – by Amanda Oldt

Disclosure: The researchers reports no relevant financial disclosures.