Psychotherapy, medication combinations, and compliance.

Combination treatment with antidepressants and psychotherapy is a common strategy in treating depression. Surprisingly little published literature on the effects of such combinations on antidepressant compliance is available. In contrast, literature is plentiful, particularly from the 1970s, on the effects of combined treatment on outcome. Although various negative interactions have at times been suggested, controlled trials are reassuring and indicate enhanced benefit, either by additive effects, by effects on different outcome measures such as symptoms or interpersonal relationships, or by mutual potentiation. A ceiling effect has been observed in some studies in which the better of the two single treatments produces as much benefit as can be obtained, with no additional benefit from the second treatment in its presence but benefit in its absence. However, it is important to note that the research designs used in most controlled trials are not adequate to study compliance because much effort is devoted toward maximizing compliance; compliance is better studied in the naturalistic situation. There is evidence in bipolar disorder that psychotherapy enhances compliance to lithium. In attaining good drug compliance in patients receiving psychotherapy, consideration needs to be given to collaboration between the drug therapist and psychotherapist, the nature of the psychotherapy, and the attitude of the psychotherapist. In general studies of compliance, patients who are engaged in treatment, are satisfied with it, and are better informed, also tend to comply better with medication regimens.