Combining pharmacotherapy and psychotherapy or monotherapy for major depression? A meta-analysis on the long-term effects
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Background The 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.Methods A 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.Results In 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).Conclusions Combined 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.
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Existing meta-analyses have compared only two interventions at a time.
“Existing metaanalyses have compared only two in terventions at a time: psychotherapy vs. pharmacotherapy 15 , combined treatment vs. psychotherapy 14 , and combined treat ment vs. pharmacotherapy 11,12 .”
From A network meta‐analysis of the effects of psychotherapies, pharmacotherapies and their combination in the treatment of adult depression (2020) · cites this paper as [14]
The combination of psychotherapy and pharmacotherapy may be more effective than either alone, but the evidence is not conclusive.
“Other pairwise metaanalyses have found that the combination of psychotherapy and pharmacotherapy may be more effective than either of these alone 11,12 , although the evi dence is not conclusive 13,14 .”
From A network meta‐analysis of the effects of psychotherapies, pharmacotherapies and their combination in the treatment of adult depression (2020) · cites this paper as [14]
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- Authors
- Karyotaki, E., Smit, Y., Holdt Henningsen, K., Huibers, M. J. H., Robays, J., de Beurs, D., & Cuijpers, P.
- Affiliations
- Amsterdam Public Health (NL)
- Belgian Health Care Knowledge Centre (KCE) (BE)
- Corresponding author
- Karyotaki, E.
- Venue
- Journal of Affective Disorders
- Publisher
- Elsevier BV
- Published
- 2016-04
- Volume
- 194
- Pages
- 144-152
- ISSN
- 0165-0327 (ISSN-L)
- OpenAlex
- W2273917694
- Cited by
- 189
- References
- 68
- Citations by year
- 2026: 15 · 2025: 8 · 2024: 17 · 2023: 15 · 2022: 28 · 2021: 35 · 2020: 19 · 2019: 22 · 2018: 6 · 2017: 14 · 2016: 8 · 2015: 1
- FWCI
- 1.91
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Affective Disorders (publishedVersion)
- PubMed (publishedVersion)
- Research Publications (Maastricht University) (publishedVersion, other-oa)
- VU Research Portal (publishedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Research Publications (Maastricht University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Disorders
- Keywords
- major depressive disorder, combined psychotherapy and pharmacotherapy, antidepressants, psychotherapy, maintenance therapy, long-term treatment response, acute phase treatment, monotherapy
- MeSH terms
- Antidepressive Agents, Combined Modality Therapy, Major Depressive Disorder, Humans, Psychotherapy, Time Factors, Randomized Controlled Trials as Topic, Treatment Outcome
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