Psychotherapy alone and combined with pharmacotherapy in the treatment of depression

BACKGROUND: The relative efficacy of psychotherapy and combined therapy in the treatment of depression is still a matter of debate. AIMS: To investigate whether combined therapy has advantages over psychotherapy alone. METHOD: A 6-month randomised clinical trial compared Short Psychodynamic Supportive Psychotherapy (n=106) with combined therapy (n=85) in ambulatory patients with mild or moderate major depressive disorder diagnosed using DSM-IV criteria. Antidepressants were prescribed according to a protocol providing four successive steps in case of intolerance or inefficacy: venlafaxine, selective serotonin reuptake inhibitor, nortriptyline and nortriptyline plus lithium. Efficacy was assessed using the 17-item Hamilton Rating Scale for Depression, the Clinical Global Impression of Severity and of Improvement, and the depression sub-scale of the Symptom Checklist. RESULTS: The advantages of combining antidepressants with psychotherapy were equivocal. Neither the treating clinicians nor the independent observers were able to ascertain them, but the patients experienced them clearly. CONCLUSIONS: The advantages of combining antidepressants with psychotherapy are equivocal.