Additive effects of combined psycho- and pharmacotherapy for depressed patients: Illusion or fact?

This article qualitatively reviews the comparative efficacy of pharmacother apy and psychotherapy vs either modality alone. Recent results are confirmi ng AHCPR statements, that, on the basis of current data, in acute treatment of Major Depressive Disorders (MDD), the routine use of both psychotherapy and pharmacotherapy is not warranted. But a methodologically outstanding s tudy from the work-group around Frank shows that, in longterm treatment of MDD-patients, combined psycho-pharmaocotherapy is superior compared to inte rpersonal psychotherapy alone, but not compared to tricyclics alone. In two settings patients might benefit substantially from a combination treatment compared to both psychotherapy and pharmacotherapy alone: 1) Acute and lon g-term treatment of more severe chronic depression, and 2) long-term treatm ent of elderly MDD-patients. More severely depressed MDD-patients profit mo re and faster if treated with combined psycho-pharmacotherapy compared comp ared to psychotherapy alone.