Hostname: page-component-76d6cb85b7-mgxrv Total loading time: 0 Render date: 2026-07-21T09:31:13.644Z Has data issue: false hasContentIssue false
  • English
  • Français

Relative efficacy of psychotherapy and combined therapy in the treatment of depression: A meta-analysis

Published online by Cambridge University Press:  16 April 2020

Saskia M. de Maat ,
Jack Dekker ,
Robert A. Schoevers  and
Frans de Jonghe
Saskia M. de Maat
Affiliation:
Mentrum Mental Health Institute Amsterdam, Klaprozenweg 111, P.O. Box 75848, 1070AVAmsterdam, Netherlands
Jack Dekker*
Affiliation:
Mentrum Mental Health Institute Amsterdam, Klaprozenweg 111, P.O. Box 75848, 1070AVAmsterdam, Netherlands
Robert A. Schoevers
Affiliation:
Mentrum Mental Health Institute Amsterdam, Klaprozenweg 111, P.O. Box 75848, 1070AVAmsterdam, Netherlands
Frans de Jonghe
Affiliation:
Mentrum Mental Health Institute Amsterdam, Klaprozenweg 111, P.O. Box 75848, 1070AVAmsterdam, Netherlands
*
*Corresponding author. Tel.: +31 20 590 5000. E-mail address: jack.dekker@mentrum.nl (J. Dekker).
Get access

Abstract

Background

Reviews of the relative efficacy of psychotherapy and combined therapy (psychotherapy with pharmacotherapy) for depression have yielded contradicting conclusions. This may be explained by the clinical heterogeneity of the studies reviewed.

Aims

To conduct a meta-analysis with an acceptable level of homogeneity in order to investigate the relative efficacy of psychotherapy and combined therapy in the acute treatment of depression.

Method

A systematic search was performed for RCTs published between 1980 and 2005 comparing psychotherapy and combined therapy in adult psychiatric outpatients with non-psychotic unipolar major depressive disorder. The studies were classified according to the chronicity and severity of the depression. Data were pooled by means of meta-analysis and statistical tests were conducted to measure heterogeneity.

Results

The meta-analysis included seven studies looking at a total of 903 patients. None of the heterogeneity tests established significance. This indicates a lack of evidence for the heterogeneity of the results. The dropout rates did not differ significantly between the two treatment modalities (25% in combined therapy and 24% in psychotherapy, p = 0.77). At treatment termination, the intention-to-treat remission rate for combined therapy (46%) was better than for psychotherapy (34%) (p = 0.0007); Relative Risk 1.32 (95% CI: 1.12–1.56), Odds Ratio 1.59 (95% CI: 1.22–2.09). In moderate depression, the difference between the remission rate for combined therapy and psychotherapy was statistically significant (47% compared to 34% respectively, p = 0.001). This was not the case in mild major depression (42% compared to 37% respectively, p = 0.29). The difference was also statistically significant in chronic major depression (48% compared to 32%, p < 0.001), but not in non-chronic major depression (43% compared to 37%, p = 0.22). On a more specific level, no differences were found in the remission rates for the treatment modalities in mild or moderate non-chronic depression. Combined therapy led to significantly better results than psychotherapy in moderate chronic depression only (48% compared to 32%, p < 0.001).

Conclusions

In the acute treatment of adult psychiatric outpatients with major depressive disorder, patient compliance with combined therapy matches compliance with psychotherapy alone. Combined therapy is more efficacious than psychotherapy alone. However, these results depend on severity and chronicity. Combined therapy outperformed psychotherapy in moderate chronic depression only. No differences were found in mild and moderate non-chronic depression. No data were found for mild chronic depression and for severe depression.

Keywords

PsychotherapyPharmacotherapyCombined therapyDepressionMajor depressive disorderMeta-analysis

Information

Type
Therapy of Depression
Information
European Psychiatry , Volume 22 , Issue 1 , January 2007 , pp. 1 - 8
Copyright
Copyright © Elsevier Masson SAS 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders. 3rd ed.Washington DC: APA; 1980 DSM-III.Google Scholar
American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders. 4th ed.Washington: APA; 1994 DSM-IV.Google Scholar
Anderson, I.M.Selective serotonin reuptake inhibitors versus tricyclic antidepressants: a meta-analysis of efficacy and tolerability. Journal of Affective disorders 2000;58:19–36.CrossRefGoogle ScholarPubMed
Beck, A.T., Hollon, S.D., Young, J.E., Bedrosian, R.C., Budenz, D.Treatment of depression with cognitive therapy and amitriptyline. Archives of General Psychiatry 1985;42:142–148.CrossRefGoogle ScholarPubMed
Bellack, A.S., Hersen, M., Himmelhoch, J.Social skills training compared with pharmacotherapy and psychotherapy in the treatment of unipolar depression. American Journal of Psychiatry 1981;138:1562–1567.Google ScholarPubMed
Beutler, L.E., Scogin, F., Kirkish, P., Schretlen, D., Corbishley, A., Hamblin, D.et al.Group cognitive therapy and alprazolam in the treatment of depression in older adults. Journal of Consulting and Clinical Psycholoy 1987;55:550–556.CrossRefGoogle ScholarPubMed
Blackburn, I.M., Bishop, S., Glen, A.I.M., Whalley, L.J., Christie, J.E.The efficacy of cognitive therapy in depression: a treatment trial using cognitive therapy and pharmacotherapy, each alone and in combination. British Journal of Psychiatry 1981;139:181–189.CrossRefGoogle ScholarPubMed
Blackburn, I.M., Bishop, S.Is there an alternative to drugs in the treatment of depressed ambulatory patients? Behavioural Psychotherapy 1981;9:96–104.CrossRefGoogle Scholar
Blackburn, I.M., Eunson, K.M., Bishop, S.A two-year naturalistic follow-up of depressed patients treated with cognitive therapy, pharmacotherapy and a combination of both. Journal of Affective disorders 1986;10:67–75.CrossRefGoogle Scholar
Blom, M.B.J., Jonker, K., Haffmans, P.M.J., Spinhoven, Ph.Combinatie van medicatie. en psychotherapie bij depressie: een overzicht. Tijdschrift voor Psychiatrie 2000;42:99–407.Google Scholar
Cochrane Collaboration, Cochrane Reviewers Handbook. Available at: http://cochrane.com. Accessed May, 2004.Google Scholar
Cohen, J.Statistical power analysis for the behavioural sciences. 2nd ed.Hillsdale, NJ: Lawrence Earlbaum Associates; 1988.Google Scholar
Conte, H.R., Plutchik, R., Wild, K., Karasu, T.B.Combined psychotherapy and pharmacotherapy for depression. Archives of General Psychiatry 1986;43:471–479.CrossRefGoogle ScholarPubMed
Elkin, I., Shea, M.T., Watkins, J.T., Imber, S.D., Sotsky, S.M., Collins, J.F.et al.National Institute of Mental Health Treatment of Depression Collaborative Research Program. Archives of General Psychiatry 1989;46:971–982.CrossRefGoogle ScholarPubMed
Evans, M.D., Hollon, S.D., DeRubeis, R.J., Piasecki, J.M., Grove, W.M., Garvey, M.J.et al.Differential relapse following cognitive therapy and pharmacotherapy for depression. Archives of General Psychiatry 1992;49:802–808.CrossRefGoogle ScholarPubMed
Frank, E., Kupfer, D.J., Perel, J.M., Cornes, C., Jarret, D.B., Malinger, A.G.et al.Three-year outcomes for maintenance therapies in recurrent depression. Archives of General Psychiatry 1990;47:1093–1099.CrossRefGoogle ScholarPubMed
Friedman, M.A., Detweiler-Bedell, J.B., Leventhal, H.E., Horne, R.M., Keitner, G.I., Miller, I.W.Combined psychotherapy and pharmacotherapy for the treatment of major depressive disorder. Clinical Psychology; Science and Practice 2004;11:47–68.CrossRefGoogle Scholar
Gaffan, E.A., Tsaousis, I., Kemp-Wheeler, S.M.Researcher allegiance and meta-analysis: the case of cognitive therapy for depression. Journal of Consulting and Clinical Psychology 1995;6:966–980.CrossRefGoogle Scholar
Hamilton, M.Development of a rating scale for primary depressive illness. British Journal of Social and Clinical Psychology 1967;6:278–296.CrossRefGoogle ScholarPubMed
Hautzinger, M., de Jong-Meyer, R., Treiber, R., Rudolf, G.A.E., Thien, U.Wirksamkeit Kognitiever Verhaltenstherapie, Pharmakotherapie und deren Kombination bei nicht-endogenen, unipolaren Depressionen. Zeitschrift für Klinische Psychologie 1996;25(2):130–145.Google Scholar
Hersen, M., Bellack, A.S., Himmelhoch, J.M., Thase, M.E.Effects of social skills training, amitriptyline and psychotherapy in unipolar depressed women. Behavioral Therapy 1984;15:21–40.CrossRefGoogle Scholar
Hollon, S.D., DeRubeis, R.J., Evans, M.D., Wiemer, M.J., Garvey, M.J., Grove, W.M.et al.Cognitive therapy and Pharmacotherapy for Depression. Singly and in combination. Archives of General Psychiatry 1992;49:774–781.CrossRefGoogle ScholarPubMed
Jarrett, R.B.Comparing and combining short-term psychotherapy and pharmacotherapy for depression. In: Beckman, E.E., Leber, W.R. editors. Handbook of depression. New York: Guilford Press.; 1995.Google Scholar
Jindal, R.D., Thase, M.E.Integrating psychotherapy and pharmacotherapy to improve outcomes among patients with mood disorders. Psychiatry Services 2003;54(11):1995. p. 1484–1490.CrossRefGoogle ScholarPubMed
de Jonghe, F., Kool, S., van Aalst, G., Dekker, J., Peen, J.Combining psychotherapy and antidepressants in the treatment of depression. Journal of Affective disorders 2001;64:217–229.CrossRefGoogle ScholarPubMed
de Jonghe, F., Hendriksen, M., Aalst, G., Kool, S., Peen, J., Van, R.et al.Psychotherapy and Combined Therapy (pharmacotherapy plus psychotherapy) in the treatment of depression. British Journal of Psychiatry 2004;185(1):37–45.CrossRefGoogle ScholarPubMed
Keitner, G.I., Posternak, M.A., Ryan, C.E.How many subjects with major depressive disorder meet eligibility requirements of an antidepressant efficacy trial? Journal of Clinical psychiatry 2003;59:598–607.Google Scholar
Keller, M.B., McCullough, J.P., Klein, D.N., Arnow, B., Dunner, D.L., Geleberg, A.J.et al.A comparison of Nefazodone, the Cognitive Behavioral-Analysis System of Psychotherapy and their combination for the treatment of chronic depression. The New England Journal of Medicine 2000;342:1462–1470.CrossRefGoogle ScholarPubMed
Leichsenring, F.Comparative effects of short-term psychodynamic psychotherapy and cognitive-behavioral therapy in depression: a meta-analytical approach. Clinical psychology Review 2001;21(3):401–419.CrossRefGoogle Scholar
de Maat, S., Dekker, J., Schoevers, R., de Jonghe, F.Relative efficacy of psychotherapy and pharmacotherapy in the treatment of depression; a meta-analysis. Psychotherapy Research 2006;16:566–578.CrossRefGoogle Scholar
Murphy, G.E., Simons, A.D., Wetzel, R.D., Lustman, P.J.Cognitive therapy and pharmacotherapy. Archives of General Psychiatry 1984;41:33–41.CrossRefGoogle ScholarPubMed
Mynor-Wallis, L.M., Gath, D.H., Day, A., Baker, F.Randomised controlled trial of problem-solving treatment, anti-depressant medication, and combined treatment for major depression in primary care. British Medical Journal 2000;320:26–30.CrossRefGoogle Scholar
O'Sullivan, R.L., Fava, M., Agustin, C., Baer, L., Rosenbaum, J.F.Sensitivity of the six-item Hamilton Depression Rating Scale. Acta Psychiatrica Scandinavcia 1997;95:379–384.CrossRefGoogle ScholarPubMed
Pampallona, S., Bollini, P., Tibaldi, G., Kupelnick, B., Munizza, C.Combined pharmacotherapy and psychological treatment for depression. A systematic review. Archives of General Psychiatry 2004;61:714–719.CrossRefGoogle ScholarPubMed
Reynolds, C.F., Miller, M.D., Pasternak, R.E., Frank, E., Perel, J.M., Cornes, C.et al.Treatment of bereavement related major depressive episodes in later life: a controlled study of acute and continuation treatment with nortryptiline and interpersonal psychotherapy. American Journal of Psychiatry 1999;156:202–208.Google Scholar
Robinson, L.A., Berman, J.S., Neimeyer, R.A.Psychotherapy for the treatment of depression: a comprehensive review of controlled outcome research. Psychological Bulletin 1990;108:30–49.CrossRefGoogle ScholarPubMed
Roth, D., Bielski, R., Jones, M., Parker, W., Osborn, G.A comparison of self-control therapy and combined self-control therapy and antidepressant medication in the treatment of depression. Behavioural Psychotherapy 1982;13:133–144.Google Scholar
Rush, A.J., Watkins, J.T.Group versus individual therapy: a pilot study. Cognitive Therapy Research 1981;5:95–103.CrossRefGoogle Scholar
Scott, C., Stradling, S.G.Group cognitive therapy for depression produces clinically significant reliable change in community based settings. Behavioural Psychotherapy 1990;18:1–19.CrossRefGoogle Scholar
Segal, Z., Vincent, P., Levitt, A.Efficacy of combined, sequential and crossover psychotherapy and pharmacotherapy in improving outcomes in depression. Journal of Psychiatry Neuroscience 2002;27(4):281–290.Google ScholarPubMed
Simons, A.D., Murphy, G.E., Levine, J.L., Wetzel, R.D.Cognitive therapy and pharmacotherapy for depression. Sustained improvement over one year. Archives of General Psychiatry 1986;43:43–48.CrossRefGoogle ScholarPubMed
Spijker, J., de Graaf, J., Bijl, R.V., Beekman, A.T.F., Ormel, J.et al.Duration of major depressive episodes in the general population: results from the Netherlands Mental Health Survey and Incidence Study (NEMESIS). British Journal of Psychiatry 2002;181:208–213.CrossRefGoogle Scholar
Spitzer, R.L., Endicott, J., Robins, E.Research Diagnostic Criteria: Rationale and Reliability. Archives of General Psychiatry 1979;35:773–785.CrossRefGoogle Scholar
Teasdale, T.D., Fennel, M.J.V., Hibbert, G.A., Amies, P.L.Cognitive therapy for major depressive disorder in primary care. British Journal of Psychiatry 1984;144:400–406.CrossRefGoogle ScholarPubMed
Thase, M.E., Greenhouse, J.B., Frank, E., Reynolds, C.F. III, Pilkonis, P.A., Hurley, K.et al.Treatment of major depression with psychotherapy or psychotherapy-pharmacotherapy combinations. Archives of General Psychiatry 1997;54:1009–1015.CrossRefGoogle ScholarPubMed
Wexler, B.E., Cicchetti, D.V.The outpatient treatment of depression. Implications of outcome research for clinical practice. The Journal of Nervous and Mental Disease 1992;180:277–286.CrossRefGoogle ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.