Antidepressants and psychological treatment: Hard reasons for synergy

Abstract

Improving the efficacy of depression treatment is a clinical necessity. «Synergy» is the systematic process in which different treatments of and approaches to mood disorders are evaluated and made to work coherently to optimize their results. Depression treatment has shown to benefit from the synergy of pharmacological and psychological processes. Our aim was to evaluate present evidence as to synergizing psychological therapy and pharmacotherapy in mood disorders, reflecting the related brain systems and circulating biological substances. Multiple brain regions are involved in mood disorders, resulting in multiple-target effects of substances, each influencing neurobiological balance, and depending on individual aspects. Large studies showed that psychological treatment may, overall, be more effective than medication. However, the synergy of both provided significantly increased effects that were largely independent of each other, and each added about 50% to the overall effects of combined treatment. Identified neuropsychobiological pathways were found, as well as appreciable evidence that, in depression, the synergy of both treatments can be expected to produce better results through reciprocal effects in cortical, subcortical and visceral systems. In compromised situations such as pregnancy and adolescence, psychological treatments for mood disorders may have preference over drug treatment, but synergy remains essential.