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Efficacy of the sequential integration of psychotherapy and pharmacotherapy in major depressive disorder: a preliminary meta-analysis

Published online by Cambridge University Press:  06 May 2010

J. Guidi ,
G. A. Fava ,
M. Fava  and
G. I. Papakostas
J. Guidi*
Affiliation:
Affective Disorders Program, Department of Psychology, University of Bologna, Italy
G. A. Fava
Affiliation:
Affective Disorders Program, Department of Psychology, University of Bologna, Italy Department of Psychiatry, State University of New York at Buffalo, Buffalo, NY, USA
M. Fava
Affiliation:
Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA Department of Psychiatry, Harvard Medical School, Boston, MA, USA
G. I. Papakostas
Affiliation:
Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA Department of Psychiatry, Harvard Medical School, Boston, MA, USA
*
*Address for correspondence: J. Guidi, Psy.D., Department of Psychology, University of Bologna, Viale Berti Pichat, 5, 40127 Bologna, Italy. (Email: [email protected])
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Abstract

Background

Prevention of relapse and recurrence represents an important task in the successful treatment of major depressive disorder (MDD). The aim of this meta-analysis was to examine the efficacy of the sequential integration of psychotherapy and pharmacotherapy in reducing the risk of relapse and recurrence in MDD.

Method

Keyword searches were conducted in Medline, EMBASE, PsycINFO and the Cochrane Library from inception of each database to December 2008. Randomized controlled trials examining the efficacy of the administration of psychotherapy after successful response to acute-phase pharmacotherapy in the treatment of adults with MDD were considered for inclusion in the meta-analysis.

Results

Eight high-quality studies with 442 patients in a sequential treatment arm and 433 in a control treatment arm were included. The pooled risk ratio (RR) for relapse/recurrence was 0.797 [95% confidence interval (CI) 0.659–0.964] according to the random-effects model, suggesting a relative advantage in preventing relapse/recurrence for the sequential administration of treatments compared with control conditions. Performing subgroup analyses, we found a trend favoring psychotherapy during continuation of antidepressant drugs compared to antidepressants or treatment as usual (RR 0.842, 95% CI 0.674–1.051). Patients randomized to psychotherapy while antidepressants were discontinued were significantly less likely to experience relapse/recurrence compared to controls (RR 0.650, 95% CI 0.463–0.912).

Conclusions

We found evidence that the sequential integration of psychotherapy and pharmacotherapy is a viable strategy for preventing relapse and recurrence in MDD. In addition, our findings suggest that discontinuation of antidepressant drugs may be feasible when psychotherapy is provided.

Keywords

Major depressive disordermeta-analysispsychotherapyrecurrencesequential treatment
Type
Original Articles
Information
Psychological Medicine , Volume 41 , Issue 2 , February 2011 , pp. 321 - 331
Copyright
Copyright © Cambridge University Press 2010

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