The DOI matches its Crossref record; 86 of the 86 references it cites were found in a registry or an index.
The Sequential Integration of Pharmacotherapy and Psychotherapy in the Treatment of Major Depressive Disorder: A Meta-Analysis of the Sequential Model and a Critical Review of the Literature
Open accessAbstract
OBJECTIVE: A number of randomized controlled trials in major depressive disorder have employed a sequential model, which consists of the use of pharmacotherapy in the acute phase and of psychotherapy in its residual phase. The aim of this review was to provide an updated meta-analysis of the efficacy of this approach in reducing the risk of relapse in major depressive disorder and to place these findings in the larger context of treatment selection. METHOD: Keyword searches were conducted in MEDLINE, EMBASE, PsycINFO, and Cochrane Library from inception of each database through October 2014. Randomized controlled trials examining the efficacy of the administration of psychotherapy after successful response to acute-phase pharmacotherapy in the treatment of adults with major depressive disorder were considered for inclusion in the meta-analysis. RESULTS: Thirteen high-quality studies with 728 patients in a sequential treatment arm and 682 in a control treatment arm were included. All studies involved cognitive-behavioral therapy (CBT). The pooled risk ratio for relapse/recurrence was 0.781 (95% confidence interval [CI]=0.671-0.909; number needed to treat=8), according to the random-effects model, suggesting a relative advantage in preventing relapse/recurrence compared with control conditions. A significant effect of CBT during continuation of antidepressant drugs compared with antidepressants alone or treatment as usual (risk ratio: 0.811; 95% CI=0.685-0.961; number needed to treat=10) was found. Patients randomly assigned to CBT who had antidepressants tapered and discontinued were significantly less likely to experience relapse/recurrence compared with those assigned to either clinical management or continuation of antidepressant medication (risk ratio: 0.674; 95% CI=0.482-0.943; number needed to treat=5). CONCLUSIONS: The sequential integration of CBT and pharmacotherapy is a viable strategy for preventing relapse in major depressive disorder. The current indications for the application of psychotherapy in major depressive disorder are discussed, with special reference to its integration with pharmacotherapy.
Overview
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“The studies that used a sequential design clearly indicated that the level of remission obtained by successful pharmacotherapy could be increased by a subsequent psychotherapeutic treatment 72 .”
From The pursuit of euthymia (2020) · cites this paper as [72]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“Adding CBT as ADMs are tapered off has also been shown to reduce the risk of subsequent relapse or recurrence (Guidi, Tomba, & Fava, 2015)”
From Risk factors for relapse and recurrence of depression in adults and how they operate: A four-phase systematic review and meta-synthesis (2018) · cites this paper as Guidi, Tomba, & Fava, 2015
The cited source says what the claim attributes to it.
In the citing paper
“Meta-analyses focusing on psychological relapse prevention interventions for depressive disorders indicate that these interventions are effective in preventing relapse, with reductions of 22–50% in relapse [18, 44–48].”
From Psychological interventions to prevent relapse in anxiety and depression: A systematic review and meta-analysis (2022) · cites this paper as [45]
The cited source says what the claim attributes to it.
In the citing paper
“This design was subsequently used in a number of randomized controlled trials and was found to entail significant benefits in a meta-analysis 72 .”
From The pursuit of euthymia (2020) · cites this paper as [72]
The check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“The UKU [57] is an example of a scale that considerably improved the detection of side effects because of its comprehensive nature.”
From Clinical Pharmacopsychology: Conceptual Foundations and Emerging Tasks (2017) · cites this paper as [57]
Experimental — accuracy not yet measured
The check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“Risk ratios with 95% confidence intervals were chosen, as they are more conservative than odds ratios are [57], and they can be easily compared with other systematic reviews [18, 44–46].”
From Psychological interventions to prevent relapse in anxiety and depression: A systematic review and meta-analysis (2022) · cites this paper as [45]
Experimental — accuracy not yet measuredIn the citing paper
“When the sequential model involves AD tapering and discontinuation, it presents the advantage of limiting AD exposure.63”
From May antidepressant drugs worsen the conditions they are supposed to treat? The clinical foundations of the oppositional model of tolerance (2020) · cites this paper as [63]
In the citing paper
“The benefits of applying psychotherapeutic strategies after pharmacotherapy has yielded its effects become maximal when drug discontinuation by slow tapering is achieved.63”
From May antidepressant drugs worsen the conditions they are supposed to treat? The clinical foundations of the oppositional model of tolerance (2020) · cites this paper as [63]
In the citing paper
“This time can be shortened to 3 months before tapering if the sequential combination of pharmacotherapy and psychotherapy is employed.63”
From May antidepressant drugs worsen the conditions they are supposed to treat? The clinical foundations of the oppositional model of tolerance (2020) · cites this paper as [63]
In the citing paper
“If prodromal symptoms may have a pathophysiological role in affective disorders and some residual symptoms may progress to become prodromal symptoms of relapse, then reduction or disappearance of residual symptomatology may entail a more favorable long-term outcome of depression.”
From Iatrogenic Factors in Psychopathology (2019) · cites this paper as [20]
In the citing paper
“Sequential treatment was thus able to favorably affect the long-term course of depressive illness and the longitudinal development of symptoms (rollback phenomenon).”
From Iatrogenic Factors in Psychopathology (2019) · cites this paper as [20]
In the citing paper
“The rollback phenomenon was later substantiated in research on mood and anxiety disorders [18,19] and was the basic idea for developing the concept of sequential treatment [20].”
From Iatrogenic Factors in Psychopathology (2019) · cites this paper as [20]
In the citing paper
“Such vulnerabilities may manifest themselves during treatment administration and/or after its discontinuation.”
From The Deceptive Manifestations of Treatment Resistance in Depression: A New Look at the Problem (2020) · cites this paper as [43]
In the citing paper
“A substantial weakness of the design of current RCT is the insufficient attention to previous treatments aside from response rates, with particular reference to iatrogenic comorbidity [43].”
From The Deceptive Manifestations of Treatment Resistance in Depression: A New Look at the Problem (2020) · cites this paper as [43]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Citations
Cites
1 retracted
Hollon, S. D., DeRubeis, R. J., Fawcett, J., Amsterdam, J. D., Shelton, R. C., Zajecka, J., Young, P. R., & Gallop, R. (2014) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2014.1054 · Cited by 179
RetractedPreferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & for the PRISMA Group (2009) · BMJ · doi:10.1136/bmj.b2535 · Cited by 83,823
Bias in meta-analysis detected by a simple, graphical test
Egger, M., Smith, G. D., Schneider, M., & Minder, C. (1997) · BMJ · doi:10.1136/bmj.315.7109.629 · Cited by 56,722
Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement.
(2009) · PubMed Central · Cited by 44,859
Quantifying heterogeneity in a meta‐analysis
Higgins, J. P. T., & Thompson, S. G. (2002) · Statistics in Medicine · doi:10.1002/sim.1186 · Cited by 36,763
Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement
Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2009) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2009.06.005 · Cited by 19,575
The combination of estimates from different experiments
Cochran, W. G. (1954) · Biometrics · doi:10.2307/3001666 · Cited by 5,380
Bergin and Garfield's Handbook of Psychotherapy and Behavior Change
Lambert, M. J. (2003) · Cited by 3,383
Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy.
Teasdale, J. D., Segal, Z. V., Williams, J. M. G., Ridgeway, V. A., Soulsby, J. M., & Lau, M. A. (2000) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.68.4.615 · Cited by 3,236
Antidepressant Drug Effects and Depression Severity: A Patient-Level Meta-analysis
Fournier, J. C., DeRubeis, R. J., Hollon, S. D., Dimidjian, S., Amsterdam, J. D., Shelton, R. C., & Fawcett, J. (2010) · JAMA · doi:10.1001/jama.2009.1943 · Cited by 2,009
Research works printed but not linked: 1
- Segal ZV, Williams JMG, Teasdale JD: Mindfulness-Based Cognitive Therapy for Depression. New York, Guilford Press, 2002
Cited by
Sorted by citations
Items 101–167 of 167
Maintenant qu’elle est bien découverte, la psychothérapie devrait être couverte !
Stip, É. (2015) · Santé mentale au Québec · doi:10.7202/1036089ar · Cited by 3
Literature study on the Efficacy of antidepressants with CBT in the treatment of depression
Menon, S., & Bhagat, V. (2022) · Research Journal of Pharmacy and Technology · doi:10.52711/0974-360x.2022.00465 · Cited by 3
The sequential approach in eating disorders: A scoping systematic review
Tomba, E., & Tecuta, L. (2023) · European Eating Disorders Review · doi:10.1002/erv.3013 · Cited by 3
Self-citationRegen, F., & Benkert, O. (2018) · Springer eBooks · doi:10.1007/978-3-662-57334-1_1 · Cited by 4
Bakker, J. M., Lieverse, R., Geschwind, N., Peeters, F. P. M. L., Myin‐Germeys, I., & Wichers, M. (2016) · Psychotherapy and Psychosomatics · doi:10.1159/000443333 · Cited by 4
Fava, G. A., & Guidi, J. (2021) · Journal of Traumatic Stress · doi:10.1002/jts.22648 · Cited by 3
Self-citationCojocaru, C. M., Popa, C. O., Suciu, N. R., Olah, P., Schenk, A., & Mureşan, S. (2021) · DOAJ (DOAJ: Directory of Open Access Journals) · doi:10.2478/amma-2021-0005 · Cited by 3
Ciasca, E. C. (2017) · Digital Library of Theses and Dissertations (Universidade de São Paulo) · doi:10.11606/d.5.2017.tde-06062017-082522 · Cited by 3
Maternal and Neonatal Risks of Untreated Major Depressive Disorder in Pregnancy
Amaru, A., Orlinsky, A., Kim, R., Paul, A., Keller, J., Alveranga, K., & Dimen, J. N. (2025) · Georgetown Medical Review · doi:10.52504/001c.136988 · Cited by 3
Woolverton, G. A., Zhao, C., Rastogi, R., Chang, A. R., Zhang, W., Lou, F., Yip, T., Liu, R. T., & Liu, C. H.-J. (2026) · Psychiatry Research · doi:10.1016/j.psychres.2026.117044 · Cited by 2
Najm, A. F., Niazi, A., Alekozay, M., Allan, E., & Mathias, K. R. (2023) · Global Health Journal · doi:10.1016/j.glohj.2023.11.002 · Cited by 2
Ferreira, F. B., Kaufmann, F. N., Bastos, C. R., Xavier, J., Aniszewski, S., Molina, M. L., Lara, D. R., Jansen, K., da Silva, R. A., Souza, L. D. D. M., et al. (2024) · Behavioural Brain Research · doi:10.1016/j.bbr.2024.115413 · Cited by 2
Sun, Q., Zhao, N., Zhang, T., Wang, S., Wang, L., & Meng, F. (2023) · Journal of Pharmaceutical and Biomedical Analysis · doi:10.1016/j.jpba.2023.115850 · Cited by 2
Chapter 35. Combining Medications and Psychotherapy
Mintz, D. L. (2022) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615375233.gg35 · Cited by 2
Efficacy of Cognitive Behaviour Therapy in Major Depressive Disorders: An Original Research
Das, G. (2024) · Journal of Pharmacy And Bioallied Sciences · doi:10.4103/jpbs.jpbs_592_23 · Cited by 1
Mindfulness-Based Interventions
Shamblaw, A. L., & Segal, Z. V. (2021) · Elsevier eBooks · doi:10.1016/b978-0-12-818697-8.00212-0 · Cited by 1
Laux, G. (2017) · Springer eBooks · doi:10.1007/978-3-662-49295-6_67 · Cited by 2
Regen, F., & Benkert, O. (2016) · Springer eBooks · doi:10.1007/978-3-662-50333-1_1 · Cited by 1
Identification and management of anxious depression in patients with treatment-resistant depression
Hershenberg, R., Rapaport, M. H., & Weischedel, K. (2022) · Elsevier eBooks · doi:10.1016/b978-0-12-824067-0.00029-3 · Cited by 1
Medicating and Technologizing Our Diagnosable Lives
Strong, T. (2017) · Springer eBooks · doi:10.1007/978-3-319-56699-3_6 · Cited by 1
New Applications of Well-Being Therapy
Benasi, G., Guidi, J., Rafanelli, C., & Fava, G. A. (2019) · RIVISTA SPERIMENTALE DI FRENIATRIA · doi:10.3280/rsf2019-001006 · Cited by 1
Self-citationFava, G. A., & Guidi, J. (2020) · Ärztliche Psychotherapie · doi:10.21706/aep-15-3-149 · Cited by 1
Self-citationWirksame Rückfallprophylaxe nach erfolgreicher Pharmakotherapie
Kriston, L. (2016) · InFo Neurologie + Psychiatrie · doi:10.1007/s15005-016-1808-3
Zhou, K., Yin, J.-B., Wu, H., Hu, W., Gao, Z., Li, F., Wu, A., Wang, W., & Kou, J. (2017) · Preprints.org · doi:10.20944/preprints201701.0138.v1
Bronsveld, J. A. (2016) · Utrecht University Repository (Utrecht University)
Pacheco, B. E. P. (2018) · ARS MEDICA Revista de Ciencias Médicas · doi:10.11565/arsmed.v43i3.1031
Klinische Wirksamkeit der Schematherapie bei Depressionen
Rein, M. L., Höhn, D., & Keck, M. E. (2018) · NeuroTransmitter · doi:10.1007/s15016-018-6218-y
Clinical staging in depression
de la Fuente-Tomás, L., & García‐Portilla, M. P. (2021) · Elsevier eBooks · doi:10.1016/b978-0-12-817933-8.00026-8
Avancées scientifiques 2021 en médecine interne générale ambulatoire
Gouveia, A., Auer, S., Baratali, L., Deillon, E., Kokkinakis, I., Leuzinger, S., Samusure, J., Selby, K. J., Tzartzas, K., Favrat, B., et al. (2022) · JMIG · doi:10.53738/revmed.2022.18.766.102
Carlson, N., & Hansen, S. E. (2022) · Evidence-Based Practice · doi:10.1097/ebp.0000000000001549
Laux, G. (2016) · Springer eBooks · doi:10.1007/978-3-642-45028-0_67-1
Psychotherapeutic interventions
Cosci, F., & Fava, G. A. (2017) · Oxford University Press eBooks · doi:10.1093/med/9780198746638.003.0018
Self-citationFava, G. A. (2018) · Elsevier eBooks · doi:10.1016/b978-2-294-76050-1.00014-3
Self-citationDepression: Third Wave Case Conceptualization
Zuo, Z., & Segal, Z. V. (2022) · Springer eBooks · doi:10.1007/978-3-031-11677-3_17
Combined Psychotherapy and Somatic Treatments
Teo, D. C. L., Silvio, J. R., Condemarín, R., Nair, S. S., Alfonso, C. A., & Tasman, A. (2023) · Springer eBooks · doi:10.1007/978-3-030-42825-9_95-1
Combined Psychotherapy and Somatic Treatments
Teo, D. C. L., Silvio, J. R., Condemarín, R., Nair, S. S., Alfonso, C. A., & Tasman, A. (2024) · Springer eBooks · doi:10.1007/978-3-030-51366-5_95
Well-Being Therapy for Depression
Romanazzo, S., & Cosci, F. (2024) · Advances in experimental medicine and biology · doi:10.1007/978-981-97-4402-2_14
Recovery and its Correlates Following Intervention in Depression
Verma, K., Singh, T. K., & Gupta, N. (2024) · Indian Journal of Social Psychiatry · doi:10.4103/ijsp.ijsp_7_24
Antidepressant Medication and Psychotherapy: Why It Matters
Chiesa, M. (2024) · British Journal of Psychotherapy · doi:10.1111/bjp.12938
Grundlagen der Diagnostik und Therapie
(2024) · Elsevier eBooks · doi:10.1016/b978-3-437-22487-4.16001-0
Rethinking the impact and management of electroconvulsive therapy session number in depression
Ji, Y., Zheng, H., Wu, Y., Wang, K., & Tian, Y. (2025) · Brain medicine : · doi:10.61373/bm025i.0053
Chapter 1. Introduction to Integrated and Split/Collaborative Treatment
(2017) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615372089.mr01
Chapter 10. Primary Care and Split/Collaborative Care
(2017) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615372089.mr10
Chapter 4. Sequencing in Integrated Treatment
(2017) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615372089.mr04
Chapter 8. Evaluation, Monitoring, and Supervision of Integrated and Split/Collaborative Treatment
(2017) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615372089.mr08
Chapter 3. Evaluation and Opening in Integrated Treatment
(2017) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615372089.mr03
Chapter 5. Selection of Medication, Psychotherapy, and Clinicians in Split/Collaborative Treatment
(2017) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615372089.mr05
Chapter 2. Selection of Medication and Psychotherapy in Integrated Treatment
(2017) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615372089.mr02
Chapter 6. Evaluation and Opening in Split/Collaborative Treatment
(2017) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615372089.mr06
Chapter 9. Termination in Integrated and Split/Collaborative Treatment
(2017) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615372089.mr09
Chapter 7. Sequencing and Maintenance in Split/Collaborative Treatment
(2017) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615372089.mr07
Competency in Combining Pharmacotherapy and Psychotherapy
Riba, M., Balon, R., & Roberts, L. W. (2017) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615372089
Deuxième module psychothérapeutique
Fava, G. A., & Peretti, C.-S. (2024) · Elsevier eBooks · doi:10.1016/b978-2-294-77932-9.00010-8
Self-citationLa décision d’arrêter de prendre des antidépresseurs
Fava, G. A., & Peretti, C.-S. (2024) · Elsevier eBooks · doi:10.1016/b978-2-294-77932-9.00005-4
Self-citationPrévention de la dépendance et de la symptomatologie du sevrage dus aux traitements antidépresseurs
Fava, G. A., & Peretti, C.-S. (2024) · Elsevier eBooks · doi:10.1016/b978-2-294-77932-9.00012-1
Self-citationDass, F. S., & Jean, A. H. S. (2025) · Springer eBooks · doi:10.1007/978-981-97-7640-5_77
Music and art therapy in age-related neuropsychiatric disorders: Creative approaches to healing
Hajizadeh, E., Salatin, S., Sarailoo, M., Amirazad, H., Azarfarin, M., & Dadkhah, M. (2025) · Progress in brain research · doi:10.1016/bs.pbr.2025.08.023
Duncan, E., Hersant, H., & Khairova, R. A. (2026) · Springer eBooks · doi:10.1007/978-3-032-15772-0_4
Verma, S., Paliwal, S., Dubey, P., Kaushik, S., Joshi, R., Dwivedi, J., & Sharma, S. K. (2026) · The Journal of Steroid Biochemistry and Molecular Biology · doi:10.1016/j.jsbmb.2026.107021
Top 50 Cited Articles on the Treatment of Major Depressive Disorder
Albesher, A. A., Muflehi, N. A., Hakami, Y. A., Barnawi, J. A., Softah, R. E., Ghalib, L. H. A., Bukhari, M., Almotiri, R. A. M., Algethami, M. S., Mahboob, S. W., et al. (2026) · Cureus · doi:10.7759/cureus.107337
Kan, S., Li, X., Chen, N., & Zhang, Y. (2026) · Medicine · doi:10.1097/md.0000000000048780
New and old challenges for clinical psychology and psychotherapy toward 2030
Castelnuovo, G. (2026) · Frontiers in Psychology · doi:10.3389/fpsyg.2026.1789643
Kamene, K. (2026) · Premier Journal of Psychology · doi:10.70389/pjp.100011
Hardy, M. S., Li, S. W., & Wilkinson, S. T. (2026) · FOCUS The Journal of Lifelong Learning in Psychiatry · doi:10.1176/appi.focus.20260001
Wang, L., Tang, R., Liu, J., Feng, J., Lu, Y., Siyu, G., Zhu, R., Duan, J., & Wang, F. (2026) · Bipolar Disorders · doi:10.1111/bdi.70191
Metadata
- Authors
- Guidi, J., Tomba, E., & Fava, G. A.
- Affiliations
- University at Buffalo, State University of New York (US)
- Venue
- American Journal of Psychiatry
- Published
- 2016-02-01
- Volume
- 173
- Issue
- 2
- Pages
- 128-137
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- OpenAlex
- W2103319508
- Cited by
- 167
- References
- 85
- Citations by year
- 2026: 9 · 2025: 6 · 2024: 14 · 2023: 8 · 2022: 13 · 2021: 17 · 2020: 20 · 2019: 15 · 2018: 20 · 2017: 32 · 2016: 12
- FWCI
- 2.72
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- major depressive disorder, sequential therapy, pharmacotherapy, psychotherapy, cognitive behavioral therapy, relapse prevention, antidepressants, treatment selection
- MeSH terms
- Antidepressive Agents, Combined Modality Therapy, Major Depressive Disorder, Humans, Psychotherapy, Recurrence, Cognitive Behavioral Therapy, Secondary Prevention
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
