title: Efficacy of the sequential integration of psychotherapy and pharmacotherapy in major depressive disorder: a preliminary meta-analysis.
abstract: BACKGROUND
  Prevention of relapse and recurrence represents an important task in the successful treatment of major depressive disorder (MDD). The aim of this meta-analysis was to examine the efficacy of the sequential integration of psychotherapy and pharmacotherapy in reducing the risk of relapse and recurrence in MDD.
  
  
  METHODS
  Keyword searches were conducted in Medline, EMBASE, PsycINFO and the Cochrane Library from inception of each database to December 2008. Randomized controlled trials examining the efficacy of the administration of psychotherapy after successful response to acute-phase pharmacotherapy in the treatment of adults with MDD were considered for inclusion in the meta-analysis.
  
  
  RESULTS
  Eight high-quality studies with 442 patients in a sequential treatment arm and 433 in a control treatment arm were included. The pooled risk ratio (RR) for relapse/recurrence was 0.797 [95% confidence interval (CI) 0.659-0.964] according to the random-effects model, suggesting a relative advantage in preventing relapse/recurrence for the sequential administration of treatments compared with control conditions. Performing subgroup analyses, we found a trend favoring psychotherapy during continuation of antidepressant drugs compared to antidepressants or treatment as usual (RR 0.842, 95% CI 0.674-1.051). Patients randomized to psychotherapy while antidepressants were discontinued were significantly less likely to experience relapse/recurrence compared to controls (RR 0.650, 95% CI 0.463-0.912).
  
  
  CONCLUSIONS
  We found evidence that the sequential integration of psychotherapy and pharmacotherapy is a viable strategy for preventing relapse and recurrence in MDD. In addition, our findings suggest that discontinuation of antidepressant drugs may be feasible when psychotherapy is provided.
authors.affiliation: Affective Disorders Program, Department of Psychology, University of Bologna, Italy. jenny.guidi2@unibo.it
authors.forename: J
authors.initials: J
authors.lastname: Guidi
authors.forename: G A
authors.initials: GA
authors.lastname: Fava
authors.forename: M
authors.initials: M
authors.lastname: Fava
authors.forename: G I
authors.initials: GI
authors.lastname: Papakostas
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000628:therapy*; D006801:Humans; D011613:Psychotherapy; D016032:Randomized Controlled Trials as Topic; D012044:Regression Analysis; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents