Combined pharmacotherapy and psychological treatment for depression: a systematic review.
BACKGROUND
Adherence to antidepressant medication use is a problem in clinical practice. Some authors have posited that combined psychological treatment facilitates adherence to pharmacotherapy.


OBJECTIVE
To study the relationship between adherence to use of and efficacy of antidepressant drugs plus psychological treatment vs drug treatment alone in depressive disorders.


METHODS
MEDLINE, Current Contents, PsychInfo, Cochrane Library, and reference lists were searched, from January 1980 to November 2002.


METHODS
Randomized clinical trials comparing antidepressant treatment alone with antidepressant treatment in combination with a psychological intervention in depressive disorders were considered. The decision to include studies in the meta-analysis was performed by 2 reviewers.


METHODS
Three independent reviewers extracted the data, using a precoded form. Methodological quality of the studies was evaluated in terms of allocation concealment and independence of evaluators.


RESULTS
Sixteen trials met the inclusion criteria, with 932 patients randomized to pharmacotherapy alone and 910 to combined treatment. Overall, patients receiving combined treatment improved significantly compared with those receiving drug treatment alone (odds ratio [OR], 1.86; 95% confidence interval [CI], 1.38-2.52), but dropouts and nonresponders did not differ in distribution between the 2 treatment modalities (OR, 0.86; 95% CI, 0.60-1.24). Studies longer than 12 weeks showed a significant advantage of combined treatment over drug treatment alone (OR, 2.21; 95% CI, 1.22-4.03), with a significant reduction in dropouts compared with nonresponders (OR, 0.59; 95% CI, 0.39-0.88). These estimates were not affected by study quality.


CONCLUSIONS
Psychological treatment combined with antidepressant therapy is associated with a higher improvement rate than drug treatment alone. In longer therapies, the addition of psychotherapy helps to keep patients in treatment. Further studies are needed to investigate whether the improvement in response attributable to the combination of drug treatment and psychotherapy can be achieved by a combination of pharmacotherapy and a compliance-enhancing intervention.
Pampallona
Sandro
S
forMed, Evolène, Switzerland.
Bollini
Paola
P
Tibaldi
Giuseppe
G
Kupelnick
Bruce
B
Munizza
Carmine
C
D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003866:Depressive Disorder / Q000188:drug therapy / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D010352:Patient Dropouts / Q000706:statistics & numerical data; D011613:Psychotherapy / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D012107:Research Design / Q000592:standards; D016896:Treatment Outcome
D000928:Antidepressive Agents