Psychotherapy, antidepressants, and their combination for chronic major depressive disorder: A systematic review

Director, Program for Mood Disorders Pro Persona, Mental Health Care, Nijmegen, the Netherlands
Canadian journal of psychiatry. Revue canadienne de psychiatrie (Impact Factor: 2.55). 07/2013; 58(7):386-92.
Source: PubMed


Recommendations for treatment of chronic major depressive disorder (cMDD) are mostly based on clinical experiences and on the literature on treatment-resistant depression (TRD) but not on a systematic review of the literature.

We conducted a systematic review of 10 randomized controlled trials (RCTs), with 17 comparisons between antidepressants (ADs), psychotherapy, or the combination of both interventions.

The best evidence is for the combination of psychotherapy and ADs, and especially for the combination of the cognitive behavourial analysis system of psychotherapy and ADs. Evidence is very weak for both ADs alone and psychotherapy alone. Assessment of TRD was mostly absent in the studies.

The best treatment for cMDD is a combination of psychotherapy and ADs. However, there is a lack of well-performed RCTs in both ADs and psychotherapy and their combination for cMDD. Therefore, the conclusions are preliminary.

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    • "Fewer than half of individuals with major depressive disorder (MDD) respond to acute treatment with antidepressant medication alone. Combined treatment of major depressive episodes (MDEs), with antidepressant medication and adjunctive psychotherapy is more effective than antidepressant medication alone (Oestergaard et al. 2011, Archer et al. 2012, Cuijpers et al. 2012, Hollinghurst et al. 2013, Oosterbaan et al. 2013, Richards et al. 2013, Spijker et al. 2013). However, 75% of depressed primary care patients report barriers that make it extremely difficult or impossible to attend regular psychotherapy sessions (Mohr et al. 2006, 2010, Dezetter et al. 2015). "
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    ABSTRACT: Background: Telephone-administered psychotherapies (T-P) provided as an adjunct to antidepressant medication may improve response rates in major depressive disorder (MDD). The goal of this study was to compare telephone-administered social rhythm therapy (T-SRT) and telephone-administered intensive clinical management (T-ICM) as adjuncts to antidepressant medication for MDD. A secondary goal was to compare T-P with Treatment as Usual (TAU) as adjunctive treatment to medication for MDD. METHODS: 221 adult out-patients with MDD, currently depressed, were randomly assigned to 8 sessions of weekly T-SRT (n=110) or T-ICM (n=111), administered as an adjunct to agomelatine. Both psychotherapies were administered entirely by telephone, by trained psychologists who were blind to other aspects of treatment. The 221 patients were a posteriori matched with 221 depressed outpatients receiving TAU (controls). The primary outcome measure was the percentage of responders at 8 weeks post-treatment. RESULTS: No significant differences were found between T-SRT and T-ICM. But T-P was associated with higher response rates (65.4% vs 54.8%, p=0.02) and a trend toward higher remission rates (33.2% vs 25.1%; p=0.06) compared to TAU. LIMITATIONS: Short term study. CONCLUSIONS: This study is the first assessing the short-term effects of an add-on, brief, telephone-administered psychotherapy in depressed patients treated with antidepressant medication. Eight sessions of weekly telephone-delivered psychotherapy as an adjunct to antidepressant medication resulted in improved response rates relative to medication alone.
    Journal of Affective Disorders 10/2015; 190:6-11. DOI:10.1016/j.jad.2015.07.052 · 3.38 Impact Factor

  • Canadian journal of psychiatry. Revue canadienne de psychiatrie 07/2013; 58(7):373-5. · 2.55 Impact Factor
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    ABSTRACT: Increasing epidemiological and experimental evidence implicates gestational infections as one important factor involved in the pathogenesis of several neuropsychiatric disorders. Corresponding preclinical model systems based upon maternal immune activation (MIA) by treatment of the pregnant female have been developed. These MIA animal model systems have been successfully used in basic and translational research approaches, contributing to the investigation of the underlying pathophysiological mechanisms at the molecular, cellular and behavioural levels. The present article focusses on the application of a specific MIA rodent paradigm, based upon treatment of the gestating dam with the viral mimic polyinosinic-poly cytidilic acid (Poly(I:C)), a synthetic analog of double-stranded RNA (dsRNA) which activates the Toll-like receptor 3 (TLR3) pathway. Important advantages and constraints of this animal model will be discussed, specifically in light of gestational infection as one vulnerability factor contributing to the complex aetiology of mood and psychotic disorders, which are likely the result of intricate multi-level gene x environment interactions. Improving our currently incomplete understanding of the molecular pathomechanistic principles underlying these disorders is a prerequisite for the development of alternative therapeutic approaches which are critically needed in light of the important drawbacks and limitations of currently available pharmacological treatment options regarding efficacy and side effects. The particular relevance of the Poly(I:C) MIA model for the discovery of novel drug targets for symptomatic and preventive therapeutic strategies in mood and psychotic disorders is highlighted in this review article.
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