Clinical guidelines for the treatment of depressive disorders. V. Combining psychotherapy and pharmacotherapy.
BACKGROUND
The Canadian Psychiatric Association and the Canadian Network for Mood and Anxiety Treatments partnered to produce clinical guidelines for psychiatrists for the treatment of depressive disorders.


METHODS
A standard guidelines development process was followed. Relevant literature was identified using a computerized Medline search supplemented by review of bibliographies. Operational criteria were used to rate the quality of scientific evidence, and the line of treatment recommendations included consensus clinical opinion. This section, "Combining Psychotherapy and Pharmacotherapy," was 1 of 7 articles drafted and reviewed by clinicians. Revised drafts underwent national and international expert peer review.


RESULTS
Recommendations are given for the use of combined psychotherapy and pharmacotherapy for the treatment of depressive disorders. Three methods of combined treatment are identified: concurrent treatment (psychotherapy plus pharmacotherapy) for the acute-treatment phase, sequential treatment (adding the other treatment for nonresponders or partial responders to monotherapy in the acute-treatment phase), and crossover treatment (switching to psychotherapy for the maintenance-treatment phase after response to pharmacotherapy in the acute phase).


CONCLUSIONS
Combined treatment with psychotherapy and pharmacotherapy is widely used in clinical practice. The recommendations for use of combined treatment are, however, based on only a limited evidence base.
Segal
Z V
ZV
Department of Psychiatry and Psychology, University of Toronto, Toronto, Ontario.
Kennedy
S H
SH
Cohen
N L
NL
D000208:Acute Disease; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003866:Depressive Disorder / Q000188:drug therapy / Q000628:therapy*; D006801:Humans; D011613:Psychotherapy; D012008:Recurrence
D000928:Antidepressive Agents