title: Effectiveness of cognitive-behavioural therapy plus pharmacotherapy in inpatient treatment of depressive disorders.
abstract: BACKGROUND
  Meta-analyses show benefits for patients from a combination of medication and cognitive-behavioural psychotherapy. However, it is still unclear whether or not additional cognitive-behavioural therapy (CBT) also produces a better treatment outcome in a naturalistic psychiatric setting.
  
  
  METHODS
  Two-hundred six consecutively registered acute psychiatric inpatients with a unipolar depressive disorder were treated with additional CBT. This combined therapy was then compared with psychiatric primary care in an inpatient setting (clinical management). In addition to pharmacological treatment, 105 of the 206 patients also received symptom-focused CBT after hospitalization. Seventeen-item Hamilton Rating Scale for Depression (HAMD, primary outcome criterion), Beck Depression Inventory (BDI), Dysfunctional Attitude Scale, Clinical Global Impression Scale and the Global Assessment of Functioning were performed with all patients.
  
  
  RESULTS
  Patients who were treated with additional CBT revealed a considerably greater reduction of depressive symptoms than in patients who received inpatient primary care only (HAMD: -22.21 versus -19.86, p = 0.027; BDI: 14.99 versus 11.36, p = 0.031). Moreover, remission rates were significantly higher (HAMD: 72% to 51%, p = 0.045; BDI: 58.8% versus 43.1%, p = 0.044) in the combined treatment group than in the primary care only group.
  
  
  CONCLUSIONS
  The naturalistic design and the inconsistent pharmacological treatment are design flaws.
  
  
  CONCLUSIONS
  The results show that additional cognitive-behavioural treatment of depressive disorders notably improves outcome over standard procedure in acute psychiatric treatment.
  
  
  CONCLUSIONS
  There is a need for treatment strategies to accompany medication. In the Sequenced Treatment Alternatives to Relieve Depression trial (STAR*D), only 33% of the patients reached remission criteria after the first antidepressant treatment step and only 50% after the second step. The strict inclusion criteria of randomized controlled trials often render their patient populations unrepresented. For an accurate view of treatment effectiveness, their results need to be complemented with results gained from trials in clinical practice. Additional cognitive-behavioural treatment notably improves treatment outcomes compared with standard treatments in the acute psychiatric treatment of depressive disorders. The results of this study under naturalistic conditions are an important addition to findings from randomized and controlled studies.
authors.affiliation: Charité University Medicine Berlin, Campus Mitte, Department of Psychiatry and Psychotherapy, Charitéplatz 1, 10117 Berlin, Germany. stephan.koehler@charite.de
authors.forename: Stephan
authors.initials: S
authors.lastname: Köhler
authors.forename: Sabine
authors.initials: S
authors.lastname: Hoffmann
authors.forename: Theresa
authors.initials: T
authors.lastname: Unger
authors.forename: Bruno
authors.initials: B
authors.lastname: Steinacher
authors.forename: Nicholas
authors.initials: N
authors.lastname: Dierstein
authors.forename: Thomas
authors.initials: T
authors.lastname: Fydrich
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy / Q000379:methods; D003866:Depressive Disorder / Q000188:drug therapy / Q000628:therapy*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007297:Inpatients / Q000523:psychology / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents