Short Psychodynamic Supportive Psychotherapy, antidepressants, and their combination in the treatment of major depression: a mega-analysis based on three Randomized Clinical Trials

Depression Research Group of the Mentrum Institute for Mental Health, Free University, Amsterdam, The Netherlands.
Depression and Anxiety (Impact Factor: 4.41). 07/2008; 25(7):565-74. DOI: 10.1002/da.20305
Source: PubMed


The efficacy of Short Psychodynamic Supportive Psychotherapy (SPSP) has not yet been compared with pharmacotherapy. A mega-analysis based on three original Randomized Clinical Trials (RCTs) was performed. Patients with (mild to moderate) major depressive disorder were randomized in (24 weeks) SPSP (n = 97), pharmacotherapy (n = 45), or their combination (n = 171). Efficacy was assessed by the Hamilton Depression Rating Scale (HDRS), Clinical Global Impression of Severity and of Improvement (CGI-S), the Symptom Checklist (SCL; depression subscale) and the Quality of Life Depression Scale (QLDS). Pearson chi(2) calculations were used to compare success rates. Analyses of covariance (ANCOVAs) were used to test inter-group differences. Success rates indicated that independent observers (HDRS) found no differences in symptom reduction between SPSP and pharmacotherapy (P = 0.214), but therapists (CGI-S, P = 0.026), and patients (SCL, P = 0.036) favored SPSP. Combined therapy was found superior to pharmacotherapy by all three (patients (P = 0.000), therapists (P = 0.024), independent observers (P = 0.024)). Independent observers (P = 0.062) and therapists (P = 0.430) found no differences between combined therapy and SPSP, but patients (P = 0.016) found combined therapy to be superior. As far as quality of life is concerned, success rates indicated that patients (QLDS) found no differences between SPSP and pharmacotherapy (P = 0.073) or between SPSP and combined therapy (P = 0.217). However, they found combined therapy superior to pharmacotherapy (P = 0.015). The results of the mega-analysis suggest that combined therapy is more efficacious than pharmacotherapy. SPSP and pharmacotherapy seem equally efficacious, except for some indications that patients and therapists favor SPSP for symptom reduction. Combined therapy and SPSP also seem equally efficacious, except that patients think that the first is better in symptom reduction.

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Available from: Robert Schoevers, Mar 13, 2015
    • "In turn, MBCT might result in accepting and acknowledging their depression more which might enhance compliance with mADM. Meta-analyses indeed showed that the combination of medication and psychological therapy was more effective than monotherapy in both current MDD (Cuijpers et al., 2014;de Maat et al., 2008;Pampallona et al., 2004) and prevention of relapse/ recurrence (Guidi et al., 2011). The combination of MBCT and mADM for prevention of relapse/ recurrence has not been studied yet. "
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    ABSTRACT: Mindfulness-based cognitive therapy (MBCT) and maintenance antidepressant medication (mADM) both reduce the risk of relapse in recurrent depression, but their combination has not been studied. Our aim was to investigate whether the addition of MBCT to mADM is a more effective prevention strategy than mADM alone. This study is one of two multicenter randomised trials comparing the combination of MBCT and mADM to either intervention on its own. In the current trial, recurrently depressed patients in remission who had been using mADM for 6 months or longer (n=68), were randomly allocated to either MBCT+mADM (n=33) or mADM alone (n=35). Primary outcome was depressive relapse/recurrence within 15 months. Key secondary outcomes were time to relapse/recurrence and depression severity. Analyses were based on intention-to-treat. There were no significant differences between the groups on any of the outcome measures. The current study included patients who had recovered from depression with mADM and who preferred the certainty of continuing medication to the possibility of participating in MBCT. Lower expectations of mindfulness in the current trial, compared with the parallel trial, may have caused selection bias. In addition, recruitment was hampered by the increasing availability of MBCT in the Netherlands, and even about a quarter of participants included in the trial who were allocated to the control group chose to get MBCT elsewhere. For this selection of recurrently depressed patients in remission and using mADM for 6 months or longer, MBCT did not further reduce their risk for relapse/recurrence or their (residual) depressive symptoms. Copyright © 2015 Elsevier B.V. All rights reserved.
    No preview · Article · Aug 2015 · Journal of Affective Disorders
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    • "First, medication and clinical management is probably the most used treatment for inpatients with major depressive episode. Second, evidence suggest that a combined treatment is recommended for severe depression [6,18]. The 12-month follow-up is naturalistic. "
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    ABSTRACT: Background A few recent studies have found indications of the effectiveness of inpatient psychotherapy for depression, usually of an extended duration. However, there is a lack of controlled studies in this area and to date no study of adequate quality on brief psychodynamic psychotherapy for depression during short inpatient stay exists. The present article describes the protocol of a study that will examine the relative efficacy, the cost-effectiveness and the cost-utility of adding an Inpatient Brief Psychodynamic Psychotherapy to pharmacotherapy and treatment-as-usual for inpatients with unipolar depression. Methods/Design The study is a one-month randomized controlled trial with a two parallel group design and a 12-month naturalistic follow-up. A sample of 130 consecutive adult inpatients with unipolar depression and Montgomery-Asberg Depression Rating Scale score over 18 will be recruited. The study is carried out in the university hospital section for mood disorders in Lausanne, Switzerland. Patients are assessed upon admission, and at 1-, 3- and 12- month follow-ups. Inpatient therapy is a manualized brief intervention, combining the virtues of inpatient setting and of time-limited dynamic therapies (focal orientation, fixed duration, resource-oriented interventions). Treatment-as-usual represents the best level of practice for a minimal treatment condition usually proposed to inpatients. Final analyses will follow an intention–to-treat strategy. Depressive symptomatology is the primary outcome and secondary outcome includes measures of psychiatric symptomatology, psychosocial role functioning, and psychodynamic-emotional functioning. The mediating role of the therapeutic alliance is also examined. Allocation to treatment groups uses a stratified block randomization method with permuted block. To guarantee allocation concealment, randomization is done by an independent researcher. Discussion Despite the large number of studies on treatment of depression, there is a clear lack of controlled research in inpatient psychotherapy during the acute phase of a major depressive episode. Research on brief therapy is important to take into account current short lengths of stay in psychiatry. The current study has the potential to scientifically inform appropriate inpatient treatment. This study is the first to address the issue of the economic evaluation of inpatient psychotherapy. Trial registration Australian New Zealand Clinical Trial Registry (ACTRN12612000909820)
    Full-text · Article · Oct 2012 · BMC Psychiatry
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    • "Lors d'un suivi d'une duré e de quatre ans, les patients ayant reçu le traitement combiné ont pré senté un taux de ré currence de dé pression significativement infé rieur a ` ceux n'ayant e ´ té traité s qu'avec la pharmacothé rapie (27,5 % vs 46,9 %). De Maat et al. [19] ont effectué une mé ganalyse regroupant trois essais cliniques randomisé s dans le but de comparer le taux de succè s obtenu chez des patients dé primé s traité s soit avec la TPB seule, la pharmacothé rapie seule, ou avec le traitement combiné . Le traitement combiné a e ´ té jugé significativement plus efficace par les patients, les thé rapeutes, et les observateurs indé pendants. "
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    ABSTRACT: With the emergence of evidence-based medicine, the place of psychodynamic therapy in psychiatric practice has been questioned in recent years. This article proposes a critical review of the scientific literature on efficacy and effectiveness of brief, long-term dynamic psychotherapy and psychoanalysis in the context of psychiatric health services. An electronic search of Medline and Psychinfo was done with relevant keywords on the topic. An overview of the efficacy of psychodynamic approaches is then provided for various disorders of axis I and axis II according to the DSM-IV. The assessment of the efficacy and effectiveness of brief, long-term dynamic psychotherapy and psychoanalysis has substantially progressed in recent years. While some gaps remain to be filled in this area, it seems that psychodynamic approaches, especially brief dynamic therapy, have a comparable efficacy with other commonly used approaches.
    Full-text · Article · Jul 2011 · Annales Médico-psychologiques revue psychiatrique
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