Effects of combined pharmacotherapy and psychotherapy for improving work functioning in major depressive disorder
Open accessAbstract
Background: Major depressive disorder is associated with significant impairment in occupational functioning and reduced productivity, which represents a large part of the overall burden of depression. Aims: To examine symptom-based and work functioning outcomes with combined pharmacotherapy and psychotherapy treatment of major depressive disorder. Method: Employed patients with a DSM-IV diagnosis of major depressive disorder were treated with escitalopram 10–20mg/day and randomised to: (a) telephone-administered cognitive-behavioural therapy (telephone CBT) (n = 48); or (b) adherence-reminder telephone calls (n = 51). Outcomes included the Montgomery-åsberg Depression Rating Scale (MADRS), administered by masked evaluators via telephone, and self-rated work functioning scales completed online. (Registered at clinicaltrials.gov: NCT00702598.) Results: After 12 weeks, there were no significant between-group differences in change in MADRS score or in response/remission rates. However, participants in the telephone-CBT group had significantly greater improvement on some measures of work functioning than the escitalopram-alone group. Conclusions: Combined treatment with escitalopram and telephone- administered CBT significantly improved some self-reported work functioning outcomes, but not symptom-based outcomes, compared with escitalopram alone.
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A number of trials have demonstrated the efficacy of an 8-session CBT intervention.
“A number of trials have demonstrated the efficacy of an 8-session CBT intervention.79,80”
From Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder (2016) · cites this paper as [80]
The CBT condition and Method sections describe an eight-session telephone CBT intervention, and the Work functioning outcomes section reports greater improvement than escitalopram alone on some productivity measures. But this paper reports one trial, not a number of trials, and its Clinical outcomes section found no significant additional benefit for depressive symptoms. It therefore supports a narrower efficacy claim than the citing sentence makes. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThe same 8-session CBT phone intervention added to an antidepressant improved work performance and satisfaction compared to antidepressant alone.
“The same 8-session CBT phone intervention added to an antidepressant improved work performance and satisfaction compared to antidepressant alone.80”
From Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder (2016) · cites this paper as [80]
The Method and CBT condition describe eight telephone CBT sessions added to escitalopram. Work functioning outcomes report greater improvement in self-rated performance for the CBT group than for the escitalopram-alone group. The Acceptability of telephone CBT section reports satisfaction with the therapy only among CBT participants; it does not show that satisfaction improved compared with the control group. (LLM, conf=0.88)
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- Authors
- Lam, R. W., Parikh, S. V., Ramasubbu, R., Michalak, E. E., Tam, E. M., Axler, A., Yatham, L. N., Kennedy, S. H., & Manjunath, C. V.
- Affiliations
- University of British Columbia Hospital (CA)
- University Health Network (CA)
- University of Calgary (CA)
- ORCID
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2013-11
- Volume
- 203
- Issue
- 5
- Pages
- 358-365
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W2160302903
- Semantic Scholar
- 46d5037da3c0403e3fdfde68e5456047b02806dc
- Cited by
- 56
- References
- 40
- Citations by year
- 2025: 2 · 2024: 3 · 2023: 4 · 2022: 3 · 2021: 3 · 2020: 5 · 2019: 6 · 2018: 5 · 2017: 5 · 2016: 10 · 2015: 6 · 2014: 3 · 2013: 1
- FWCI
- 4.90
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Bristol-Myers Squibb
- Eli Lilly and Company
- Pfizer
- AstraZeneca
- GlaxoSmithKline
- Servier
- H. Lundbeck A/S
- Lundbeck Canada
- Topics
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- major depressive disorder, work functioning, occupational functioning, escitalopram, combined psychotherapy and pharmacotherapy, symptom remission, employed patients
- MeSH terms
- Adult, Aged, Combined Modality Therapy, Depressive Disorder, Major, Major Depressive Disorder, Employment, Female, Humans, Male, Middle Aged, Psychiatric Status Rating Scales, Citalopram, Cognitive Behavioral Therapy, Outcome Assessment, Health Care, Telemedicine, Selective Serotonin Reuptake Inhibitors, Young Adult, Intention to Treat Analysis, Self Report
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