Combining pharmacotherapy and psychotherapy - the example of depressive disorders

Abstract

The debate about whether to use psychopharmacology or psychotherapy has shifted from an “either / or” debate to a rational discussion of combination therapy or sequential therapy. This paper discusses the reasons for this academic shift. The implications of this scientific debate are the choice of modality in a particular clinical condition, augmentation effects, prevention of relapse and recurrence with continuation treatment, the sequential application of psychotherapy and pharmacotherapy, improvement of compliance. Major depression is used as an example of a disorder where the combination of psychotherapy and pharmacotherapy offer great advantages. The evidence for the efficacy of this combination reviewed and discussed. The studies looking at the neurobiological effects of psychotherapy is reviewed and discussed. The practical aspects of combination therapy are presented and problems inherent are indicated and the effectiveness presented. Finally the Canadian Psychiatric Association’s comprehensive evidence based clinical guideline for the treatment of depressive disorders is discussed as it relates to combination treatment. The conclusion is that an expanding body of evidence in the use of psychotherapy and psychopharmacology in combination is guiding us. As further studies are done, clearer guidelines will emerge leading to improve evidence-based practice of these modalities.

SA Psych Rev 2003; 19-21