The outpatient treatment of depression. Implications of outcome research for clinical practice.
Multiple studies have demonstrated that individual psychotherapy, pharmacotherapy, and the two in combination are all effective treatments for depressed outpatients. However, the implications of these data for clinical practice have been incompletely considered, and the often drawn mistaken conclusion is that they support routine treatment with psychotherapy and pharmacotherapy together. Analyses of treatment success rates, treatment failure rates, and treatment dropout rates indicate that combined treatment offers no advantage over treatment with psychotherapy alone and only modest advantage over treatment with pharmacotherapy alone. Routine use of combined treatment, therefore, exposes patients to unnecessary costs and side effects. The data suggest that psychotherapy alone should usually be the initial treatment.
Wexler
B E
BE
Department of Psychiatry, Yale University, New Haven.
Cicchetti
D V
DV
D000553:Ambulatory Care; D000928:Antidepressive Agents / Q000627:therapeutic use*; D001521:Behavior Therapy; D002986:Clinical Trials as Topic; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D003866:Depressive Disorder / Q000523:psychology / Q000628:therapy*; D006801:Humans; D015201:Meta-Analysis as Topic; D016017:Odds Ratio; D010352:Patient Dropouts; D011613:Psychotherapy; D016896:Treatment Outcome
D000928:Antidepressive Agents