Psychotherapy sequential integration may reduce risk for MDD relapse

Sequential integration of psychotherapy following response to acute-phase pharmacotherapy was associated with a reduced risk for relapse in patients with major depressive disorder, according to study results published in JAMA Psychiatry.

“The sequential model consists in the consecutive application of two forms of treatment, psychotherapy after pharmacotherapy and pharmacotherapy after psychotherapy, and sequential use of two psychotherapeutic or pharmacological strategies,” Jenny Guidi, PhD, and Giovanni Fava, MD, both of the department of psychology at the University of Bologna in Italy, wrote. “The rationale of this approach is to use psychotherapeutic strategies when they are most likely to make a unique and separate contribution to a patient’s well-being and to achieve a more pervasive recovery.”

In a meta-analysis to examine the association of sequential combination with reduced risk for MDD relapse, researchers extracted 17 randomized clinical trials that included 2,283 participants, of whom 1,208 were in a sequential treatment arm and 1,075 in a control arm, via electronic database search. Researchers further computed the risk ratio of relapse or recurrence from each study and based examination of pooled results on the random-effects model.

Analysis showed the pooled risk ratio for relapse or recurrence of MDD was 0.835 (95% CI, 0.743-0.938). Researchers noted these results suggest a relative advantage of sequential treatment combination in preventing relapse or recurrence when compared with controlled conditions.

“The sequential integration of psychotherapy after successful administration of antidepressant medication during the acute phase of MDD appears to be an effective strategy that yields enduring results,” the researchers wrote.