Integrating psychotherapy after response to medication helped reduce relapse and recurrence of major depressive disorder (MDD), whether or not pharmacotherapy was continued, researchers found in a systematic review and meta-analysis.
“The pooled risk ratio for relapse/recurrence of MDD was 0.84 (95% CI, 0.74-0.94), suggesting a relative advantage in preventing relapse/recurrence for the sequential combination of treatments compared with control conditions,” reported Jenny Guidi, PhD, of the University of Bologna, Italy, and Giovanni A. Fava, MD, of the State University of New York, Buffalo.
The study analyzed 17 randomized clinical trials with a total of 2283 adult participants. Findings were published online in JAMA Psychiatry.
The authors recommended assessing patients 3 months after starting a course of medication, focusing on residual symptoms, and deciding whether pharmacotherapy should be continued. They recommend starting cognitive behavioral treatment next, and if discontinuing medication, tapering at the slowest pace possible to minimize the risk of withdrawal symptoms. The patient should then be assessed one month after psychotherapy is completed, they wrote.
“The sequential model emerged from the awareness that the persistence of residual symptoms and the frequent occurrence of psychiatric comorbidity were both associated with poor long-term outcome of MDD,” the researchers wrote.
“The sequential model introduces a conceptual shift in clinical practice, and discontinuation of antidepressant drugs may be feasible when a sequential treatment model is used.”
Guidi J, Fava GA. Sequential combination of pharmacotherapy and psychotherapy in major depressive disorder: a systematic review and meta-analysis. JAMA Psychiatry. 2020 November 25;[Epub ahead of print].