Psychotherapy and medication in the treatment of adult and geriatric depression: which monotherapy or combined treatment?
OBJECTIVE
The authors reviewed the literature with respect to the relative efficacy of medications and psychotherapy alone and in combination in the treatment of depression.


METHODS
Findings from empirical studies comparing medications and psychotherapy alone and in combination were synthesized and prognostic and prescriptive indices identified. We searched both MEDLINE and PsychINFO for items published from January 1980 to October 2004 using the following terms: treatment of depression, psychotherapy and depression, and pharmacotherapy and depression. Studies were selected that randomly assigned depressed patients to combined treatment versus monotherapy.


RESULTS
Medication typically has a rapid and robust effect and can prevent symptom return so long as it is continued or maintained, but does little to reduce risk once its use is terminated. Both interpersonal psychotherapy (IPT) and cognitive-behavioral therapy (CBT) can be as effective as medications in the acute treatment of depressed outpatients. Interpersonal psychotherapy may improve interpersonal functioning, whereas CBT appears to have an enduring effect that reduces subsequent risk following treatment termination. Ongoing treatment with either IPT or CBT appears to further reduce risk. Treatment with the combination of medication and IPT or CBT retains the specific benefits of each and may enhance the probability of response over either monotherapy, especially in chronic depressions.


CONCLUSIONS
Both medication and certain targeted psychotherapies appear to be effective in the treatment of depression. Although several prognostic indices have been identified that predict need for longer or more intensive treatment, few prescriptive indices have yet been established to select among the different treatments. Combined treatment can improve response with selected patients and enhance its breadth (IPT) or stability (CBT).
Hollon
Steven D
SD
Department of Psychology, Vanderbilt University, Nashville, TN 37203, USA. steven.d.hollon@vanderbilt.edu
Jarrett
Robin B
RB
Nierenberg
Andrew A
AA
Thase
Michael E
ME
Trivedi
Madhukar
M
Rush
A John
AJ
D000328:Adult; D000367:Age Factors; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D002986:Clinical Trials as Topic / Q000706:statistics & numerical data; D015928:Cognitive Behavioral Therapy / Q000379:methods; D003866:Depressive Disorder / Q000188:drug therapy* / Q000517:prevention & control / Q000628:therapy*; D004359:Drug Therapy, Combination; D005196:Family Therapy; D006801:Humans; D008388:Marital Therapy; D017410:Practice Guidelines as Topic; D011569:Psychiatric Status Rating Scales; D011613:Psychotherapy / Q000379:methods*; D055502:Secondary Prevention; D016896:Treatment Outcome
D000928:Antidepressive Agents