Combination of pharmacotherapy and psychotherapy in the treatment of chronic depression: A systematic review and meta-analysis

BMC Psychiatry

Levente Kriston¹  Martin Härter¹  Annika Westphal¹  Lars P Hölzel²  Alessa von Wolff¹ 

[1] Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany;Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany

关键词: Systematic review;    Meta-analysis;    Pharmacotherapy;    Psychotherapy;    Chronic depression;   

Others  :  1124370
DOI  :  10.1186/1471-244X-12-61

 received in 2012-02-06, accepted in 2012-06-13,  发布年份 2012

【 摘 要 】

Background

Chronic depression represents a substantial portion of depressive disorders and is associated with severe consequences. This review examined whether the combination of pharmacological treatments and psychotherapy is associated with higher effectiveness than pharmacotherapy alone via meta-analysis; and identified possible treatment effect modifiers via meta-regression-analysis.

Methods

A systematic search was conducted in the following databases: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, ISI Web of Science, BIOSIS, PsycINFO, and CINAHL. Primary efficacy outcome was a response to treatment; primary acceptance outcome was dropping out of the study. Only randomized controlled trials were considered.

Results

We identified 8 studies with a total of 9 relevant comparisons. Our analysis revealed small, but statistically not significant effects of combined therapies on outcomes directly related to depression (BR = 1.20) with substantial heterogeneity between studies (I² = 67%). Three treatment effect modifiers were identified: target disorders, the type of psychotherapy and the type of pharmacotherapy. Small but statistically significant effects of combined therapies on quality of life (SMD = 0.18) were revealed. No differences in acceptance rates and the long-term effects between combined treatments and pure pharmacological interventions were observed.

Conclusions

This systematic review could not provide clear evidence for the combination of pharmacotherapy and psychotherapy. However, due to the small amount of primary studies further research is needed for a conclusive decision.

【 授权许可】

   
2012 von Wolff et al.; licensee BioMed Central Ltd.

【 图 表 】

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