Clinical guidelines for the treatment of depressive disorders V. Combiningpsychotherapy and pharmacotherapy

Background: The Canadian Psychiatric Association and the Canadian Network f or Mood and Anxiety Treatments partnered to produce clinical guidelines for psychiatrists for the treatment of depressive disorders. Methods: A standard guidelines development process was followed. Relevant l iterature was identified using a computerized Medline search supplemented b y review of bibliographies. Operational criteria were used to rate the qual ity of scientific evidence, and the line of treatment recommendations inclu ded consensus clinical opinion. This section, "Combining Psychotherapy and Pharmacotherapy, "was 1 of 7 articles drafted and reviewed by clinicians. R evised drafts underwent national and international expert review. Results: Recommendations are given for the use of combined psychotherapy an d pharmacotherapy for the treatment of depressive disorders. Three methods of combined treatment are identified. concurrent treatment (psychotherapy p lus pharmacotherapy) for the acute-treatment phase, sequential treatment (a dding the other treatment for nonresponders or partial responders to monoth erapy in the acute-treatment phase), and crossover treatment (switching to psychotherapy for the maintenance-treatment phase after response to pharmac otherapy in the acute phase). Conclusions: Combined treatment with psychotherapy and pharmacotherapy is w idely used in clinical practice. The recommendations for use of combined tr eatment ave, however based on only a limited evidence base.