A research team from the University of Bologna in Italy have published a new meta-anlaysis that explores the sequential integration of psychotherapy and pharmacotherapy in reducing the risk of relapse and recurrence in major depressive disorder.

They searched a range of databases for randomised controlled trials that tested the efficacy of the administration of psychotherapy after successful response to acute-phase pharmacotherapy in the treatment of adults with depression. They found 8 good quality trials, which when combined, involved 442 patients in a sequential treatment arm and 433 in a control treatment arm.

Their analysis turned up some promising results:

• The pooled risk ratio (RR) for relapse/recurrence was 0.797 [95% confidence interval (CI) 0.659-0.964] according to the random-effects model, suggesting a relative advantage in preventing relapse/recurrence for the sequential administration of treatments compared with control conditions
• Psychotherapy during continuation of antidepressant drugs compared favourably to antidepressants or treatment as usual (RR 0.842, 95% CI 0.674-1.051)
• Patients randomised to psychotherapy while antidepressants were discontinued were significantly less likely to experience relapse/recurrence compared to controls (RR 0.650, 95% CI 0.463-0.912).

We found evidence that the sequential integration of psychotherapy and pharmacotherapy is a viable strategy for preventing relapse and recurrence in major depressive disorder. In addition, our findings suggest that discontinuation of antidepressant drugs may be feasible when psychotherapy is provided.

Guidi J, Fava GA, Fava M, Papakostas GI. Efficacy of the sequential integration of psychotherapy and pharmacotherapy in major depressive disorder: a preliminary meta-analysis. Psychol Med. 2011 Feb;41(2):321-31. Epub 2010 May 6. [PubMed abstract]