Should combined pharmaco- and psychotherapy be offered to depressed patients? A qualitative review of randomized clinical trials from the 1990s.

Focusing on recent publications from the 1990s, this article qualitatively reviews the comparative efficacy of the combination of pharmaco- and psychotherapy (COMBI) vs either modality alone. There is only a weak empirical basis recommending the routine use of both psychotherapy and pharmacotherapy in acute treatment of Major Depressive Disorders (MDD). Concerning long-term treatment of MDD patients, the methodologically sophisticated study from Frank et al. shows that a COMBI is superior to interpersonal psychotherapy but not superior to medication alone. However, certain subgroups of patients might benefit substantially from COMBI compared to both psychotherapy and pharmacotherapy alone: 1) acute and long-term treatment of more severe forms of chronic depression, and 2) long-term treatment of older MDD patients. Compared to psychotherapy alone, severely depressed MDD patients profit more and faster when treated with combined psycho-pharmacotherapy.