Faster remission of chronic depression with combined psychotherapy and medication than with each therapy alone.
The main aim of the present novel reanalysis of archival data was to compare the time to remission during 12 weeks of treatment of chronic depression following antidepressant medication (n = 218), psychotherapy (n = 216), and their combination (n = 222). Cox regression survival analyses revealed that the combination of medication and psychotherapy produced full remission from chronic depression more rapidly than either of the single modality treatments, which did not differ from each other. Receiver operating characteristic curve analysis was used to explore predictors (treatment group, demographic, clinical, and psychosocial) of remission. For those receiving the combination treatment, the most likely to succeed were those with low baseline depression (24-item Hamilton Rating Scale for Depression [HRSD; M. Hamilton, 1967] score < 26) and those with high depression scores but low anxiety (HRSD = 26 and Hamilton Anxiety Rating Scale [M. Hamilton, 1959] < 14). Both profiles were associated with at least 40% chance of attaining full remission. The model did not identify predictors for those receiving medication or psychotherapy alone, and it did not distinguish between the 2 monotherapies. The authors conclude that combined antidepressant medications and psychotherapy result in faster full remission of chronic forms of major depressive disorder.
Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA. rmanber@stanford.edu
Rachel
R
Manber
Helena C
HC
Kraemer
Bruce A
BA
Arnow
Madhukar H
MH
Trivedi
A John
AJ
Rush
Michael E
ME
Thase
Barbara O
BO
Rothbaum
Daniel N
DN
Klein
James H
JH
Kocsis
Alan J
AJ
Gelenberg
Martin E
ME
Keller
D000293:Adolescent; D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D001008:Anxiety Disorders / Q000453:epidemiology / Q000628:therapy; D002908:Chronic Disease; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010879:Piperazines; D011569:Psychiatric Status Rating Scales; D012372:ROC Curve; D012074:Remission Induction; D012720:Severity of Illness Index; D013997:Time Factors; D014230:Triazoles / Q000627:therapeutic use*
D000928:Antidepressive Agents; D010879:Piperazines; D014230:Triazoles; C051752:nefazodone