Combining pharmacotherapy and psychotherapy or monotherapy for major depression? A meta-analysis on the long-term effects

• The long-term effects of combined therapy are not well known.
• Acute phase combined therapy results in equal effects to psychotherapy alone.
• Acute phase combined therapy results in better effects to antidepressants alone
• Similar outcomes were observed for maintenance treatment.
• Conclusions couldn't be drawn for maintenance combined therapy vs. psychotherapy

BackgroundThe 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.MethodsA 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.ResultsIn 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).ConclusionsCombined 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.