S. Bellino, M. Zizza, R. Di Lorenzo, E. Paradiso, R. Falakfarsa, M. Fulcheri, F. Bogetto - Vol. 8, December 2002, Issue 4
Testo Immagini Bibliografia Summary Indice
Terapia combinata del disturbo depressivo
maggiore: revisione critica della letteratura
Combined therapy of major depressive disorder: a critical review
The present paper is a review of recent literature concerning combination of
antidepressant drugs and psychotherapy in the treatment of patients with major
depressive disorder.
Psychotherapies commonly used in the treatment of depressive disorders are presented: behaviour therapy, cognitive therapy, interpersonal therapy, and brief psychodynamic therapy. Each therapy is described, providing a brief account of theoretical concepts and specific techniques and reporting efficacy data from single trials and meta-analyses.
Available results suggest general indications about acute phase and maintenance treatment of depression. In the acute phase treatment of mild to moderate depression, psychotherapies have the same efficacy of antidepressants and cognitive-behaviour therapies have overlapping results with interpersonal and brief dynamic interventions. In more severe depressive disorders, drug therapy has the same efficacy of interpersonal therapy, but is probably superior to cognitive-behaviour interventions. In maintenance treatment, a long-term antidepressant therapy and a maintenance psychotherapy have been found both efficacious in preventing relapses.
Currently, more than 50% of psychiatric patients receive a combined therapy. Anyway, systematic studies of the efficacy of this intervention in patients with major depression are promising, but still insufficient to conclude that combined therapy is superior to drug therapy or psychotherapy alone.
A few authors prefer to perform a sequential treatment using antidepressants in acute phase therapy and psychotherapy in the subsequent maintenance phase. Drugs would induce an initial improvement, that would increase patients’ resources and promote a better response to the successive psychotherapeutic intervention.
A series of open questions concerning proper modalities of combined therapy need to be focused: which clinical characteristics are a specific indication for this therapy? Does any contraindication exist? Do the associated therapies have an effect of augmentation or are they directed at different, specific targets? What is cost-effectiveness of combined therapy? Is it better to associate treatments from the beginning or choose a sequential treatment? Is it a single therapist model preferable to a two therapists one? Partial responses to these questions by recent studies are reported. However, each topic needs to be investigated with a specific design, an adequate methodology and reliable evaluation instruments.