In an effort to reduce the risk of relapse or recurrence of major depressive disorder (MDD), a meta-analysis of more than a dozen studies looked at the potential impact of using a sequential combination of pharmacotherapy and psychotherapy.
Published in JAMA Psychiatry, the study examined the results of 17 clinical trials, including more than 2,200 patients.
The trials looked at the difference between patients who underwent psychotherapy after acute-phase pharmacotherapy, those who underwent psychotherapy alone, or those who combined psychotherapy and antidepressant medication.
“The chronic and recurrent nature of MDD represents a major clinical challenge,” the authors said. ‘Prevention of relapse and recurrence appears to be a crucial task for successful treatment.”
The first step in the process, according to the authors, is a “careful assessment” three months after starting antidepressants, followed by the administration of a cognitive-behavioral treatment of residual symptoms, including homework exposure, and/or mindfulness-based cognitive therapy.
The authors suggested psychotherapy can be divided into two sections, one concerned with residual symptomatology and the other modulating psychotherapeutic strategies.
“These latter strategies are ideal for making the patient aware of a state of allostatic overload, such as chronic and subtle life stresses, excessive workloads, and sleeping habits, with ensuing suggestions for lifestyle modification,” the authors said, adding that patients should be assessed one month after ending treatment.
The total patient population from all the trials included 1,208 patients who received sequential treatment and 1,075 in the control arm.
The pooled risk ratio for relapse or recurrence of MDD was 0.84, which the authors said suggested a “relative advantage” in preventing relapse or recurrence for sequential combination, which they described as introducing a “conceptual shift in clinical practice.”
The authors also noted that the sequential combination could lessen the need for antidepressants for patients with the condition. However, they caution it should be done slowly to minimize the risk of withdrawal.
“The result of this systematic review and meta-analysis indicate that the sequential integration of psychotherapy following response to acute-phase pharmacotherapy, alone or combined with antidepressant medication, was associated with reduced risk of relapse and recurrence in MDD,” the authors said.
