Psychotherapy and Medication in the Treatment of Adult and Geriatric Depression: Which Monotherapy or Combined Treatment?
J Clin Psychiatry 2005;66(4):455-468
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Objective: The authors reviewed the literature
with respect to the relative efficacy of medications and
psychotherapy alone and in combination in the treatment of
Data Sources and Study Selection: Findings
from empirical studies comparing medications
and psychotherapy alone and in combination
were synthesized and prognostic and prescriptive
indices identified. We searched both MEDLINE
and PsychINFO for items published from January
1980 to October 2004 using the following terms:
treatment of depression, psychotherapy and depression,
and pharmacotherapy and depression.
Studies were selected that randomly assigned depressed
patients to combined treatment versus
Data Synthesis: Medication typically has a
rapid and robust effect and can prevent symptom
return so long as it is continued or maintained,
but does little to reduce risk once its use is terminated.
Both interpersonal psychotherapy (IPT)
and cognitive-behavioral therapy (CBT) can be
as effective as medications in the acute treatment
of depressed outpatients. Interpersonal psychotherapy
may improve interpersonal functioning,
whereas CBT appears to have an enduring effect
that reduces subsequent risk following treatment
termination. Ongoing treatment with either IPT
or CBT appears to further reduce risk. Treatment
with the combination of medication and IPT or
CBT retains the specific benefits of each and may
enhance the probability of response over either
monotherapy, especially in chronic depressions.
Conclusion: Both medication and certain
targeted psychotherapies appear to be effective
in the treatment of depression. Although several
prognostic indices have been identified that predict
need for longer or more intensive treatment,
few prescriptive indices have yet been established
to select among the different treatments. Combined
treatment can improve response with selected
patients and enhance its breadth (IPT)
or stability (CBT).