Psychotherapy and Medication in the Treatment of Adult and Geriatric Depression: Which Monotherapy or Combined Treatment?

Objective: The authors reviewed the literature with respect to the relative efficacy of medications and psychotherapy alone and in combination in the treatment of depression.

Data Sources and Study Selection: Findingsfrom empirical studies comparing medicationsand psychotherapy alone and in combinationwere synthesized and prognostic and prescriptiveindices identified. We searched both MEDLINEand PsychINFO for items published from January1980 to October 2004 using the following terms:treatment of depression, psychotherapy and depression,and pharmacotherapy and depression.Studies were selected that randomly assigned depressedpatients to combined treatment versusmonotherapy.

Data Synthesis: Medication typically has arapid and robust effect and can prevent symptomreturn 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 beas effective as medications in the acute treatmentof depressed outpatients. Interpersonal psychotherapymay improve interpersonal functioning,whereas CBT appears to have an enduring effectthat reduces subsequent risk following treatmenttermination. Ongoing treatment with either IPTor CBT appears to further reduce risk. Treatmentwith the combination of medication and IPT orCBT retains the specific benefits of each and mayenhance the probability of response over eithermonotherapy, especially in chronic depressions.

Conclusion: Both medication and certaintargeted psychotherapies appear to be effectivein the treatment of depression. Although severalprognostic indices have been identified that predictneed for longer or more intensive treatment,few prescriptive indices have yet been establishedto select among the different treatments. Combinedtreatment can improve response with selectedpatients and enhance its breadth (IPT)or stability (CBT).’ ‹