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Psychotherapy and medication in the treatment of adult and geriatric depression: which monotherapy or combined treatment?
J Clin Psychiatry 2005; 66(4):455-68JC

Abstract

OBJECTIVE

The authors reviewed the literature with respect to the relative efficacy of medications and psychotherapy alone and in combination in the treatment of depression.

DATA SOURCES AND STUDY SELECTION

Findings from empirical studies comparing medications and psychotherapy alone and in combination were synthesized and prognostic and prescriptive indices identified. We searched both MEDLINE and PsychINFO for items published from January 1980 to October 2004 using the following terms: treatment of depression, psychotherapy and depression, and pharmacotherapy and depression. Studies were selected that randomly assigned depressed patients to combined treatment versus monotherapy.

DATA SYNTHESIS

Medication typically has a rapid and robust effect and can prevent symptom return so long as it is continued or maintained, but does little to reduce risk once its use is terminated. Both interpersonal psychotherapy (IPT) and cognitive-behavioral therapy (CBT) can be as effective as medications in the acute treatment of depressed outpatients. Interpersonal psychotherapy may improve interpersonal functioning, whereas CBT appears to have an enduring effect that reduces subsequent risk following treatment termination. Ongoing treatment with either IPT or CBT appears to further reduce risk. Treatment with the combination of medication and IPT or CBT retains the specific benefits of each and may enhance the probability of response over either monotherapy, especially in chronic depressions.

CONCLUSION

Both medication and certain targeted psychotherapies appear to be effective in the treatment of depression. Although several prognostic indices have been identified that predict need for longer or more intensive treatment, few prescriptive indices have yet been established to select among the different treatments. Combined treatment can improve response with selected patients and enhance its breadth (IPT) or stability (CBT).

Authors+Show Affiliations

Department of Psychology, Vanderbilt University, Nashville, TN 37203, USA. steven.d.hollon@vanderbilt.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.
Review

Language

eng

PubMed ID

15816788

Citation

Hollon, Steven D., et al. "Psychotherapy and Medication in the Treatment of Adult and Geriatric Depression: Which Monotherapy or Combined Treatment?" The Journal of Clinical Psychiatry, vol. 66, no. 4, 2005, pp. 455-68.
Hollon SD, Jarrett RB, Nierenberg AA, et al. Psychotherapy and medication in the treatment of adult and geriatric depression: which monotherapy or combined treatment? J Clin Psychiatry. 2005;66(4):455-68.
Hollon, S. D., Jarrett, R. B., Nierenberg, A. A., Thase, M. E., Trivedi, M., & Rush, A. J. (2005). Psychotherapy and medication in the treatment of adult and geriatric depression: which monotherapy or combined treatment? The Journal of Clinical Psychiatry, 66(4), pp. 455-68.
Hollon SD, et al. Psychotherapy and Medication in the Treatment of Adult and Geriatric Depression: Which Monotherapy or Combined Treatment. J Clin Psychiatry. 2005;66(4):455-68. PubMed PMID: 15816788.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Psychotherapy and medication in the treatment of adult and geriatric depression: which monotherapy or combined treatment? AU - Hollon,Steven D, AU - Jarrett,Robin B, AU - Nierenberg,Andrew A, AU - Thase,Michael E, AU - Trivedi,Madhukar, AU - Rush,A John, PY - 2005/4/9/pubmed PY - 2005/5/25/medline PY - 2005/4/9/entrez SP - 455 EP - 68 JF - The Journal of clinical psychiatry JO - J Clin Psychiatry VL - 66 IS - 4 N2 - OBJECTIVE: The authors reviewed the literature with respect to the relative efficacy of medications and psychotherapy alone and in combination in the treatment of depression. DATA SOURCES AND STUDY SELECTION: Findings from empirical studies comparing medications and psychotherapy alone and in combination were synthesized and prognostic and prescriptive indices identified. We searched both MEDLINE and PsychINFO for items published from January 1980 to October 2004 using the following terms: treatment of depression, psychotherapy and depression, and pharmacotherapy and depression. Studies were selected that randomly assigned depressed patients to combined treatment versus monotherapy. DATA SYNTHESIS: Medication typically has a rapid and robust effect and can prevent symptom return so long as it is continued or maintained, but does little to reduce risk once its use is terminated. Both interpersonal psychotherapy (IPT) and cognitive-behavioral therapy (CBT) can be as effective as medications in the acute treatment of depressed outpatients. Interpersonal psychotherapy may improve interpersonal functioning, whereas CBT appears to have an enduring effect that reduces subsequent risk following treatment termination. Ongoing treatment with either IPT or CBT appears to further reduce risk. Treatment with the combination of medication and IPT or CBT retains the specific benefits of each and may enhance the probability of response over either monotherapy, especially in chronic depressions. CONCLUSION: Both medication and certain targeted psychotherapies appear to be effective in the treatment of depression. Although several prognostic indices have been identified that predict need for longer or more intensive treatment, few prescriptive indices have yet been established to select among the different treatments. Combined treatment can improve response with selected patients and enhance its breadth (IPT) or stability (CBT). SN - 0160-6689 UR - https://www.unboundmedicine.com/medline/citation/15816788/full_citation L2 - http://www.psychiatrist.com/jcp/article/pages/2005/v66n04/v66n0408.aspx DB - PRIME DP - Unbound Medicine ER -