Treatment of Major Depression With Psychotherapy or Psychotherapy-Pharmacotherapy Combinations

doi:10.1001/archpsyc.1997.01830230043006

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Vol. 54 No. 11, November 1997

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Treatment of Major Depression With Psychotherapy or Psychotherapy-Pharmacotherapy Combinations

Michael E. Thase, MD; Joel B. Greenhouse, PhD; Ellen Frank, PhD; Charles F. Reynolds III, MD; Paul A. Pilkonis, PhD; Katharine Hurley, MS; Victoria Grochocinski, PhD; David J. Kupfer, MD

Arch Gen Psychiatry. 1997;54(11):1009-1015.

Abstract

Background
Few reliable correlates of treatment response in depressionhave emerged despite nearly 40 years of research. We examinedthe correlates of recovery in a "mega-analysis," or meta-analysisof original data, of 595 patients with major depressive disorderenrolled in 6 standardized treatment protocols.

Methods
All patients (mean age, 44 years; 31% male and 69% female) metcriteria for nonbipolar, nonpsychotic primary major depressivedisorder and were treated for 16 weeks with either cognitivebehavior therapy or interpersonal psychotherapy alone (psychotherapyalone; n=243) or interpersonal psychotherapy plus antidepressantpharmacotherapy (combined therapy; n=352). The impact of treatmenttype, severity, study, and other covariates on recovery ratesor time to recovery were examined by means of ${chi}$ ², log-rank tests,the Cox proportional hazards model, and sensitivity analyses.

Results
Whereas combined therapy was not significantly more effectivethan psychotherapy alone in milder depressions, a highly significantadvantage was observed in more severe recurrent depressions.Poorer outcomes were also observed in women and older patients,although these effects were dependent on inclusion of particularstudies.

Conclusions
Mega-analysis is a powerful method for comparing the efficacyof treatments and examining correlates of response. Using thismethod, we found new evidence in support of the widespread clinicalimpression that combined therapy is superior to psychotherapyalone for treatment of more severe, recurrent depressions.

Author Affiliations

From the Western Psychiatric Institute and Clinic and Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pa.

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