TREATMENT OF MAJOR DEPRESSION WITH PSYCHOTHERAPY OR PSYCHOTHERAPY-PHARMACOTHERAPY COMBINATIONS

Background: Few reliable correlates of treatment response in depressio n have emerged despite nearly 40 years of research. We examined the co rrelates of recovery in a ''mega-analysis,'' or meta-analysis of origi nal data, of 595 patients with major depressive disorder enrolled in 6 standardized treatment protocols. Methods: All patients (mean age, 44 years; 31% male and 69% female) met criteria for nonbipolar, nonpsych otic primary major depressive disorder and were treated for 16 weeks w ith either cognitive behavior therapy or interpersonal psychotherapy a lone (psychotherapy alone; n=243) or interpersonal psychotherapy plus antidepressant pharmacotherapy (combined therapy; n=352). The impact o f treatment type, severity, study, and other covariates on recovery ra tes or time to recovery were examined by means of chi(2), log-rank tes ts, the Cox proportional hazards model, and sensitivity analyses. Resu lts: Whereas combined therapy was not significantly more effective tha n psychotherapy alone in milder depressions, a highly significant adva ntage was observed in more severe recurrent depressions. Poorer outcom es were also observed in women and older patients, although these effe cts were dependent on inclusion of particular studies. Conclusions: Me ga-analysis is a powerful method for comparing the efficacy of treatme nts and examining correlates of response. Using this method, we found new evidence in support of the widespread clinical impression that com bined therapy is superior to psychotherapy alone for treatment of more severe, recurrent depressions.