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Psychotherapy and medication in the treatment of adult and geriatric depression: which monotherapy or combined treatment?

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).

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  • Authors+Show Affiliations

    ,

    Department of Psychology, Vanderbilt University, Nashville, TN 37203, USA. steven.d.hollon@vanderbilt.edu

    , , , ,

    Source

    The Journal of clinical psychiatry 66:4 2005 Apr pg 455-68

    MeSH

    Adult
    Age Factors
    Aged
    Antidepressive Agents
    Clinical Trials as Topic
    Cognitive Behavioral Therapy
    Depressive Disorder
    Drug Therapy, Combination
    Family Therapy
    Humans
    Marital Therapy
    Practice Guidelines as Topic
    Psychiatric Status Rating Scales
    Psychotherapy
    Secondary Prevention
    Treatment Outcome

    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 -