title: Combining pharmacotherapy and psychotherapy or monotherapy for major depression? A meta-analysis on the long-term effects.
abstract: BACKGROUND
  The present meta-analysis aimed to examine to what extent combined pharmacotherapy with psychotherapy results in a different response to treatment compared to psychotherapy or pharmacotherapy alone in adults with major depression at six months or longer postrandomization.
  
  
  METHODS
  A systematic literature search resulted in 23 randomized controlled trials with 2184 participants. Combined treatment was compared to either psychotherapy or anti-depressant medication alone in both the acute phase and the maintenance phase. Odds ratios of a positive outcome were calculated for all comparisons.
  
  
  RESULTS
  In acute phase treatment, combined psychotherapy with antidepressants outperformed antidepressants alone at six months or longer postrandomization in patients with major depressive disorder (OR=2.93, 95%CI 2.15-3.99, p<0.001). Heterogeneity was zero (95%CI 0-57%, p>0.05). However, combined therapy resulted in equal response to treatment compared to psychotherapy alone at six months or longer postrandomization. As for the maintenance treatment, combined maintenance psychotherapy with antidepressants resulted in better-sustained treatment response compared to antidepressants at six months or longer postrandomization (OR=1.61, 95%CI 1.14-2.27, p<0.05). Heterogeneity was zero (95%CI 0-68%, p>0.05).
  
  
  CONCLUSIONS
  Combined therapy results in a superior enduring effect compared to antidepressants alone in patients with major depression. Psychotherapy is an adequate alternative for combined treatment in the acute phase as it is as effective as combined treatment in the long-term.
authors.affiliation: Department of Clinical Psychology, EMGO Institute for Health and Care Research, VU University and VU University medical centre, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, VU University medical centre, Amsterdam, The Netherlands. Electronic address: e.karyotaki@vu.nl.
authors.forename: E
authors.initials: E
authors.lastname: Karyotaki
authors.affiliation: Independant researcher, The Netherlands.
authors.forename: Y
authors.initials: Y
authors.lastname: Smit
authors.affiliation: ME-TA DK, Medical and health technology assessment, Denmark.
authors.forename: K
authors.initials: K
authors.lastname: Holdt Henningsen
authors.affiliation: Department of Clinical Psychology, EMGO Institute for Health and Care Research, VU University and VU University medical centre, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, VU University medical centre, Amsterdam, The Netherlands.
authors.forename: M J H
authors.initials: MJ
authors.lastname: Huibers
authors.affiliation: Belgian Health Care Knowledge Centre, KCE, Brussels, Belgium.
authors.forename: J
authors.initials: J
authors.lastname: Robays
authors.affiliation: Department of Clinical Psychology, EMGO Institute for Health and Care Research, VU University and VU University medical centre, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, VU University medical centre, Amsterdam, The Netherlands.
authors.forename: D
authors.initials: D
authors.lastname: de Beurs
authors.affiliation: Department of Clinical Psychology, EMGO Institute for Health and Care Research, VU University and VU University medical centre, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, VU University medical centre, Amsterdam, The Netherlands.
authors.forename: P
authors.initials: P
authors.lastname: Cuijpers
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000628:therapy*; D006801:Humans; D011613:Psychotherapy; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents