When are psychotherapy and pharmacotherapy combinations the treatment of choice for major depressive disorder?

Abstract

Treating major depressive disorder with the combination of psychotherapy and pharmacotherapy is highly valued by both psychiatrists and their patients. However, results of most systematic research studies suggest that this approach may be overvalued: evidence of additive benefits (in relation to the respective component therapies, alone) is meager. In this paper it is argued that the advantage of combined treatment may be limited to treatment of patients with more complex depressive disorders, including characteristics such as comorbidity, chronicity, treatment resistance, episodicity, and severity. Said another way, milder acute depressions, especially initial or sporadic episodes, probably do not warrant the routine use of psychotherapy and pharmacotherapy. By focusing attention on the patient subgroups most likely to show a true additive response to combined treatment, it may be possible to obtain maximum benefits from dwindling resources.