Combination Treatment for Long-Term Recovery from Depression?

Steven Dubovsky, MD

Adding cognitive therapy to antidepressant treatment seems to work best in patients with nonchronic, more severe depression.

In a multicenter study, researchers examined whether, in the long run, antidepressants work better alone or combined with psychotherapy. The participants, 452 adults (mean age, 43) with nonpsychotic, unipolar depression (mean Hamilton Rating Scale for Depression [HRSD] score, 22), were randomized to algorithm-driven, manufacturer-provided antidepressants alone or with cognitive therapy (CT). Psychiatrists or nurse practitioners managed medications, and therapists determined CT frequency.

Depression remission (full, HRSD, ≤8 for 4 weeks; partial, HRSD, ≤12 after 1 year) was achieved by 187 of 227 combined-treatment recipients and 170 of 225 monotherapy recipients, who then entered the continuation phase (total duration, ≤42 months).

Although remission rates showed no group differences, rates of recovery (26 weeks without relapse [HRSD score, ≥16]) were significantly higher with combined treatment. This difference was largely attributable to a 2.34 greater chance of recovery with combined treatment in nonchronic, more severe depression (HRSD ≥22), for which the number needed to treat was just 3. Adding CT did not increase antidepressants' benefit in chronic or less severe depression.

Citation(s):

Hollon SD et al. Effect of cognitive therapy with antidepressant medications vs antidepressants alone on the rate of recovery in major depressive disorder: A randomized clinical trial. JAMA Psychiatry 2014 Oct 1; 71:1157.