title: Psychotherapy, antidepressants, and their combination for chronic major depressive disorder: a systematic review.
abstract: OBJECTIVE
  Recommendations for treatment of chronic major depressive disorder (cMDD) are mostly based on clinical experiences and on the literature on treatment-resistant depression (TRD) but not on a systematic review of the literature.
  
  
  METHODS
  We conducted a systematic review of 10 randomized controlled trials (RCTs), with 17 comparisons between antidepressants (ADs), psychotherapy, or the combination of both interventions.
  
  
  RESULTS
  The best evidence is for the combination of psychotherapy and ADs, and especially for the combination of the cognitive behavourial analysis system of psychotherapy and ADs. Evidence is very weak for both ADs alone and psychotherapy alone. Assessment of TRD was mostly absent in the studies.
  
  
  CONCLUSIONS
  The best treatment for cMDD is a combination of psychotherapy and ADs. However, there is a lack of well-performed RCTs in both ADs and psychotherapy and their combination for cMDD. Therefore, the conclusions are preliminary.
authors.affiliation: Program for Mood Disorders Pro Persona, Mental Health Care, Nijmegen, the Netherlands. jspijker@trimbos.nl
authors.forename: Jan
authors.initials: J
authors.lastname: Spijker
authors.forename: Annemieke
authors.initials: A
authors.lastname: van Straten
authors.forename: Claudi L H
authors.initials: CL
authors.lastname: Bockting
authors.forename: Jolanda A C
authors.initials: JA
authors.lastname: Meeuwissen
authors.forename: Anton J L M
authors.initials: AJ
authors.lastname: van Balkom
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use*; D002908:Chronic Disease; D003131:Combined Modality Therapy / Q000379:methods*; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000628:therapy*; D006801:Humans; D011613:Psychotherapy / Q000379:methods*; D016032:Randomized Controlled Trials as Topic / Q000592:standards*
chemical_list: D000928:Antidepressive Agents
keywords: antidepressants; chronic major depressive disorder; psychotherapy; systematic review