0
Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

INFLUENTIAL PUBLICATIONS   |    
Adding Psychotherapy to Antidepressant Medication in Depression and Anxiety Disorders: a Meta-Analysis
Pim Cuijpers; Marit Sijbrandij; Sander L. Koole; Gerhard Andersson; Aartjan T. Beekman; Charles F. Reynolds, III
FOCUS 2014;12:347-358. doi:10.1176/appi.focus.12.3.347
Abstract

We conducted a meta-analysis of randomized trials in which the effects of treatment with antidepressant medication were compared to the effects of combined pharmacotherapy and psychotherapy in adults with a diagnosed depressive or anxiety disorder. A total of 52 studies (with 3,623 patients) met inclusion criteria, 32 on depressive disorders and 21 on anxiety disorders (one on both depressive and anxiety disorders). The overall difference between pharmacotherapy and combined treatment was Hedges’ g = 0.43 (95% CI: 0.31-0.56), indicating a moderately large effect and clinically meaningful difference in favor of combined treatment, which corresponds to a number needed to treat (NNT) of 4.20. There was sufficient evidence that combined treatment is superior for major depression, panic disorder, and obsessive-compulsive disorder (OCD). The effects of combined treatment compared with placebo only were about twice as large as those of pharmacotherapy compared with placebo only, underscoring the clinical advantage of combined treatment. The results also suggest that the effects of pharmacotherapy and those of psychotherapy are largely independent from each other, with both contributing about equally to the effects of combined treatment. We conclude that combined treatment appears to be more effective than treatment with antidepressant medication alone in major depression, panic disorder, and OCD. These effects remain strong and significant up to two years after treatment. Monotherapy with psychotropic medication may not constitute optimal care for common mental disorders.

(Reprinted with permission from the World Psychiatry 2014;13:56–67) 

Abstract Teaser
Figures in this Article

Your Session has timed out. Please sign back in to continue.
Sign In Your Session has timed out. Please sign back in to continue.
Sign In to Access Full Content
 
Username
Password
Sign in via Athens (What is this?)
Athens is a service for single sign-on which enables access to all of an institution's subscriptions on- or off-site.
Not a subscriber?

Subscribe Now/Learn More

PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development.

Need more help? PsychiatryOnline Customer Service may be reached by emailing PsychiatryOnline@psych.org or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).

Figure 1. Selection and Inclusion of Studies. GAD – Generalized Anxiety Disorder, OCD – Obsessive-Compulsive Disorder, PTSD – Post-Traumatic Stress Disorder, SAD – Social Anxiety Disorder

Figure 2. Effects of Pharmacotherapy Compared to Combined Treatment With Pharmacotherapy and Psychotherapy (Hedges’ g)
Anchor for Jump
Table 1.Selected Characteristics of Studies Comparing Treatment with Antidepressant Medication to Combined Treatment with Psychotherapy and Medication
Table Footer Note

* A positive or negative sign is given for four quality criteria: allocation sequence, concealment of allocation to conditions, blinding of assessors, and intention-to-treat analysis

Table Footer Note

BT – behavior therapy, CBT – cognitive behavior therapy, DYN – psychodynamic therapy, DYS – dysthymic disorder, GAD – generalized anxiety disorder, IPT – interpersonal psychotherapy, MAOI – monoamine oxidase inhibitor, MDD – major depressive disorder, Mood – mixed mood disorder, Ncom – number of patients in the combined treatment condition, Nmed – number of patients in the pharmacotherapy condition, OCD – obsessive-compulsive disorder, PAN – panic disorder with or without agoraphobia, Prot/Other – other antidepressant or protocolized treatment with antidepressants, PST – problem-solving therapy, PTSD – post-traumatic stress disorder, SAD – social anxiety disorder, SNRI – serotonin-norepinephrine reuptake inhibitor, SSRI – selective serotonin reuptake inhibitor, TCA – tricyclic antidepressant

Anchor for Jump
Table 2.Effects of Combined Therapy for Adult Depressive and Anxiety Disorders Compared with Antidepressant Medication Only
Table Footer Note

CBT – cognitive behavior therapy, GAD – generalized anxiety disorder, IPT – interpersonal psychotherapy, Ncomp – number of comparisons, NNT – number needed to treat, OCD – obsessive-compulsive disorder, PTSD – post-traumatic stress disorder, SAD – social anxiety disorder, SNRI – serotonin-norepinephrine reuptake inhibitor, SSRI – selective serotonin reuptake inhibitor, TCA – tricyclic antidepressant

Anchor for Jump
Table 3.Direct Comparisons Between Psychotherapy, Pharmacotherapy, Combined Psychotherapy and Pharmacotherapy, and Placebo in Anxiety and Depressive Disorders (Hedges’ g)
Table Footer Note

Ncomp - number of comparisons, NNT – number needed to treat

Anchor for Jump
Table 4.Long-term Follow-up Effects in Included Studies: Definitions of Positive Outcome and Relative Risk Associated With Each Outcome
Table Footer Note

BDI – Beck Depression Inventory, CGI – Clinical Global Impression, FQ – Fear Questionnaire, FQ-AG – Fear Questionnaire, Agoraphobia Subscale, HAMA – Hamilton Anxiety Rating Scale, HAMD – Hamilton Depression Rating Scale, PDSS – Postpartum Depression Screening Scale, RR – relative risk, SRT – Kellner and Sheffield Symptom Rating Scale, YBOCS – Yale-Brown Obsessive Compulsive Scale

Anchor for Jump
Table 5.Long-Term Effects of Combined Therapy for Anxiety and Depressive Disorders Compared with Antidepressive Medication Only: Relative Risk of Having a Positive Outcome
Table Footer Note

Ncomp – number of comparisons, NNT – Number needed to treat, RR – relative risk

+

References

Kessler  RC;  Berglund  P;  Demler  O  et al.  National Comorbidity Survey Replication. The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R).  JAMA 2003;289:3095–105.
[CrossRef] | [PubMed]
 
Kessler  RC;  Berglund  P;  Demler  O  et al.  Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication.  Arch Gen Psychiatry 2005;62:593–602.
[CrossRef] | [PubMed]
 
Ustun  TB;  Ayuso-Mateos  JL;  Chatterji  S  et al.  Global burden of depressive disorders in the year 2000.  Br J Psychiatry 2004;184:386–92.
[CrossRef] | [PubMed]
 
Saarni  SI;  Suvisaari  J;  Sintonen  H  et al.  Impact of psychiatric disorders on health-related quality of life: general population survey.  Br J Psychiatry 2007;190:326–32.
[CrossRef] | [PubMed]
 
Berto  P;  D’Ilario  D;  Ruffo  P  et al.  Depression: cost-of-illness studies in the international literature: a review.  J Ment Health Policy Econ 2000;3:3–10.
[CrossRef] | [PubMed]
 
Greenberg  PE;  Birnbaum  HG.  The economic burden of depression in the US: societal and patient perspectives.  Exp Opin Pharmacother 2005;6:369–76.
[CrossRef]
 
Smit  F;  Cuijpers  P;  Oostenbrink  J  et al.  Excess costs of common mental disorders: population based cohort study.  J Ment Health Policy Econ 2006;9:193–200.
[PubMed]
 
Mathers  CD;  Loncar  D.  Projections of global mortality and burden of disease from 2002 to 2030.  PLoS Med 2006;3:e442.
[CrossRef] | [PubMed]
 
National Institute for Health and Clinical Excellence (NICE).  Depression; the treatment and management of depression in adults.  Holborn: NICE , 2009.
 
Bauer  M;  Bschor  T;  Pfennig  A  et al.  World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of unipolar depressive disorders in primary care.  World J Biol Psychiatry 2007;8:67–104.
[CrossRef] | [PubMed]
 
Bandelow  B;  Sher  L;  Bunevicius  R  et al.  Guidelines for the pharmacological treatment of anxiety disorders, obsessive-compulsive disorder and posttraumatic stress disorder in primary care.  Int J Psychiatry Clin Pract 2012;16:77–84.
[CrossRef] | [PubMed]
 
Cuijpers  P;  Sijbrandij  M;  Koole  SL  et al.  The efficacy of psychotherapy and pharmacotherapy in treating depressive and anxiety disorders: a meta-analysis of direct comparisons.  World Psychiatry 2013;12:137–48.
[CrossRef] | [PubMed]
 
Cuijpers  P;  Dekker  J;  Hollon  SD  et al.  Adding psychotherapy to pharmacotherapy in the treatment of depressive disorders in adults: a meta-analysis.  J Clin Psychiatry 2009;70:1219–29.
[CrossRef] | [PubMed]
 
Cuijpers  P;  van Straten  A;  Warmerdam  L  et al.  Psychological treatment versus combined treatment of depression: a meta-analysis.  Depress Anx 2009;26:279–88.
[CrossRef]
 
de Maat  SM;  Dekker  J;  Schoevers  RA  et al.  Relative efficacy of psychotherapy and combined therapy in the treatment of depression: a meta-analysis.  Eur Psychiatry 2007;22:1–8.
[CrossRef] | [PubMed]
 
Olfson  M;  Marcus  SC.  National trends in outpatient psychotherapy.  Am J Psychiatry 2010;167:1456–63.
[CrossRef] | [PubMed]
 
Marcus  SC;  Olfson  M.  National trends in the treatment for depression from 1998 to 2007.  Arch Gen Psychiatry 2010;67:1265–73.
[CrossRef] | [PubMed]
 
Furukawa  TA;  Watanabe  N;  Churchill  R.  Combined psychotherapy plus antidepressants for panic disorder with or without agoraphobia.  Cochrane Database of Systematic Reviews 2007 (1): CD004364.
 
Hofmann  SG;  Sawyer  AT;  Korte  KJ  et al.  Is it beneficial to add pharmacotherapy to cognitive-behavioral therapy when treating anxiety disorders? A meta-analytic review.  Int J Cogn Ther 2009; 2:160–75.
[CrossRef] | [PubMed]
 
Higgins  JPT;  Green  S (eds).  Cochrane handbook for systematic reviews of interventions. Version 5.0.1 .  Oxford:  Cochrane Collaboration, 2008.
 
Hedges  LV;  Olkin  I.  Statistical methods for meta-analysis .  San Diego:  Academic Press, 1985.
 
Kraemer  HC;  Kupfer  DJ.  Size of treatment effects and their importance to clinical research and practice.  Biol Psychiatry 2006;59:990–6.
[CrossRef] | [PubMed]
 
Laupacis  A;  Sackett  DL;  Roberts  RS.  An assessment of clinically useful measures of the consequences of treatment.  N Engl J Med 1988;318:1728–33.
[CrossRef] | [PubMed]
 
Higgins  JP;  Thompson  SG;  Deeks  JJ  et al.  Measuring inconsistency in meta-analyses.  BMJ 2003;327:557–60.
[CrossRef] | [PubMed]
 
Ioannidis  JPA;  Patsopoulos  NA;  Evangelou  E.  Uncertainty in heterogeneity estimates in meta-analyses.  BMJ 2007;335:914–6.
[CrossRef] | [PubMed]
 
Orsini  N;  Higgins  J;  Bottai  M  et al.  Heterogi: Stata module to quantify heterogeneity in a meta-analysis.  Boston:  Boston College Department of Economics, 2005.
 
Duval  S;  Tweedie  R.  Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis.  Biometrics 2000;56:455–63.
[CrossRef] | [PubMed]
 
Azhar  MZ.  Comparison of Fluvoxamine alone, Fluvoxamine and cognitive psychotherapy and psychotherapy alone in the treatment of panic disorder in Kelantan – implications for management by family doctors.  Med J Malaysia 2000;55:402–8.
[PubMed]
 
Barlow  DH;  Gorman  JM;  Shear  MK  et al.  Cognitive-behavioral therapy, imipramine, or their combination for panic disorder: a randomized controlled trial.  JAMA 2000;283:2529–36.
[CrossRef] | [PubMed]
 
Bellack  AS;  Hersen  M;  Himmelhoch  J.  Social skills training compared with pharmacotherapy and psychotherapy in the treatment of unipolar depression.  Am J Psychiatry 1981;138:1562–67.
[PubMed]
 
Bellino  S;  Zizza  M;  Camilla  R  et al.  Combined treatment of major depression in patients with borderline personality disorder: a comparison with pharmacotherapy.  Can J Psychiatry 2006;51:253–60.
 
Berger  P;  Sachs  G;  Amering  M  et al.  Personality disorder and social anxiety predict delayed response in drug and behavioral treatment of panic disorder.  J Affect Disord 2004;80:75–8.
[CrossRef] | [PubMed]
 
Blackburn  IM;  Bishop  S;  Glen  AI  et al.  The efficacy of cognitive therapy in depression: a treatment trial using cognitive therapy and pharmacotherapy, each alone and in combination.  Br J Psychiatry 1981;139:181–9.
[CrossRef] | [PubMed]
 
Blanco  C;  Heimberg  RG;  Schneier  FR  et al.  A placebo-controlled trial of phenelzine, cognitive behavioral group therapy, and their combination for social anxiety disorder.  Arch Gen Psychiatry 2010;67:286–95.
[CrossRef] | [PubMed]
 
Blom  MB;  Spinhoven  P;  Hoffman  T  et al.  Severity and duration of depression, not personality factors, predict short term outcome in the treatment of major depression.  J Affect Disord 2007; 104:119–26.
[CrossRef] | [PubMed]
 
Blomhoff  S;  Haug  TT;  Hellström  K  et al.  Randomised controlled general practice trial of sertraline, exposure therapy and combined treatment in generalised social phobia.  Br J Psychiatry 2001;179:23–30.
[CrossRef] | [PubMed]
 
Browne  G;  Steiner  M;  Roberts  J  et al.  Sertraline and/or interpersonal psychotherapy for patients with dysthymic disorder in primary care: 6-month comparison with longitudinal 2-year follow-up of effectiveness and costs.  J Affect Disord 2002;68:317–30.
[CrossRef] | [PubMed]
 
Burnand  Y;  Andreoli  A;  Kolatte  E  et al.  Psychodynamic psychotherapy and clomipramine in the treatment of major depression.  Psychiatr Serv 2002;53:585–90.
[CrossRef] | [PubMed]
 
Crits-Christoph  P;  Newman  MG;  Rickels  K  et al.  Combined medication and cognitive therapy for generalized anxiety disorder.  J Anxiety Disord 2011;25:1087–94.
[CrossRef] | [PubMed]
 
Davidson  JRT;  Foa  EB;  Huppert  JD  et al.  Fluoxetine, comprehensive cognitive behavioral therapy, and placebo in generalized social phobia.  Arch Gen Psychiatry 2004;61:1005–13.
[CrossRef] | [PubMed]
 
de Jonghe  F;  Kool  S;  van Aalst  G  et al.  Combining psychotherapy and antidepressants in the treatment of depression.  J Affect Disord 2001;64:217–29.
[CrossRef] | [PubMed]
 
de Mello  MF;  Myczcowisk  LM;  Menezes  PR.  A randomized controlled trial comparing moclobemide and moclobemide plus interpersonal psychotherapy in the treatment of dysthymic disorder.  J Psychother Pract Res 2001;10:117–23.
[PubMed]
 
Dozois  DJA;  Bieling  PJ;  Patelis-Siotis  I  et al.  Changes in self-schema structure in cognitive therapy for major depressive disorder: a randomized clinical trial.  J Consult Clin Psychol 2009;77:1078–88.
[CrossRef] | [PubMed]
 
Finkenzeller  W;  Zobel  I;  Rietz  S  et al.  Interpersonal psychotherapy and pharmacotherapy for post-stroke depression. Feasibility and effectiveness.  Nervenarzt 2009;80:805–12.
[CrossRef] | [PubMed]
 
Foa  EB;  Liebowitz  MR;  Kozak  MJ  et al.  Randomized, placebo-controlled trial of exposure and ritual prevention, clomipramine, and their combination in the treatment of obsessive-compulsive disorder.  Am J Psychiatry 2005;162:151–61.
[CrossRef] | [PubMed]
 
Hautzinger  M;  de Jong-Meyer  R;  Treiber  R  et al.  Wirksamkeit Kognitiever Verhaltenstherapie, Pharmacotherapie und deren Kombination bei nicht-endogenen, unipolaren Depressionen.  Zeitschr Klin Psychol 1996;25:130–45.
 
Hellerstein  DJ;  Little  SAS;  Samstag  LW  et al.  Adding group psychotherapy to medication treatment in dysthymia: a randomized prospective pilot study.  J Psychother Pract Res 2001;10:93–103.
[PubMed]
 
Hollon  SD;  DeRubeis  RJ;  Evans  MD  et al.  Cognitive therapy and pharmacotherapy for depression: singly and in combination.  Arch Gen Psychiatry 1992;49:774–81.
[CrossRef] | [PubMed]
 
Hsiao  FH;  Jow  GM;  Lai  YM  et al.  The long-term effects of psychotherapy added to pharmacotherapy on morning to evening diurnal cortisol patterns in outpatients with major depression.  Psychother Psychosom 2011;80:166–72.
[CrossRef] | [PubMed]
 
Keller  MB;  McCullough  JP;  Klein  DN  et al.  A comparison of nefazodone, the cognitive behavioral-analysis system of psychotherapy, and their combination for the treatment of chronic depression.  N Engl J Med 2000;342:1462–70.
[CrossRef] | [PubMed]
 
King  ALS;  Valenca  AM;  de Melo-Neto  VL  et al.  Efficacy of a specific model for cognitive-behavioral therapy among panic disorder patients with agoraphobia: a randomized clinical trial.  Sao Paulo Med J 2011;129:325–34.
[CrossRef] | [PubMed]
 
Koszycki  D;  Taljaard  M;  Segal  Z  et al.  A randomized trial of sertraline, self-administered cognitive behavior therapy, and their combination for panic disorder.  Psychol Med 2011;41:373–83.
[CrossRef] | [PubMed]
 
Lesperance  F;  Frasure-Smith  N;  Koszycki  D  et al.  Effects of citalopram and interpersonal psychotherapy on depression in patients with coronary artery disease: the Canadian Cardiac Randomized Evaluation of Antidepressant and Psychotherapy Efficacy (CREATE) trial.  JAMA 2007;297:367–79.
[CrossRef] | [PubMed]
 
Loerch  B;  Graf-Morgenstern  M;  Hautzinger  M  et al.  Randomised placebo-controlled trial of moclobemide, cognitive-behavioural therapy and their combination in panic disorder with agoraphobia.  Br J Psychiatry 1999;174:205–12.
[CrossRef] | [PubMed]
 
Lynch  TR;  Morse  JQ;  Mendelson  T  et al.  Dialectical behavior therapy for depressed older adults: a randomized pilot study.  Am J Geriatr 2003;11:33–45.
[CrossRef]
 
Macaskill  ND;  Macaskill  A.  Rational-emotive therapy plus pharmacotherapy vs. pharmacotherapy alone in the treatment of high cognitive dysfunction depression.  Cogn Ther Res 1996;20:575–92.
[CrossRef]
 
Maina  G;  Rosso  G;  Rigardetto  S  et al.  No effect of adding brief dynamic therapy to pharmacotherapy in the treatment of obsessive-compulsive disorder with concurrent major depression.  Psychother Psychosom 2010;79:295–302.
[CrossRef] | [PubMed]
 
Markowitz  JC;  Kocsis  JH;  Bleiberg  KL  et al.  A comparative trial of psychotherapy and pharmacotherapy for “pure” dysthymic patients.  J Affect Disord 2005;89:167–75.
[CrossRef] | [PubMed]
 
Misri  S;  Reebye  P;  Corral  M  et al.  The use of paroxetine and cognitive-behavioral therapy in postpartum depression and anxiety: a randomized controlled trial.  J Clin Psychiatry 2004;65:1236–41.
[CrossRef] | [PubMed]
 
Mitchell  PH;  Veith  RC;  Becker  KJ  et al.  Brief psychosocial-behavioral intervention with antidepressant reduces poststroke depression significantly more than usual care with antidepressant: living well with stroke: randomized, controlled trial.  Stroke 2009;40:3073–8.
[CrossRef] | [PubMed]
 
Murphy  GE;  Simons  AD;  Wetzel  RD  et al.  Cognitive therapy and pharmacotherapy. Singly and together in the treatment of depression.  Arch Gen Psychiatry 1984;41:33–41.
[CrossRef] | [PubMed]
 
Mynors-Wallis  LM;  Gath  DH;  Day  A  et al.  Randomised controlled trial of problem solving treatment, antidepressant medication, and combined treatment for major depression in primary care.  BMJ 2000;320:26–30.
[CrossRef] | [PubMed]
 
Naeem  F;  Waheed  W;  Gobbi  M  et al.  Preliminary evaluation of culturally sensitive CBT for depression in Pakistan: findings from Developing Culturally-sensitive CBT Project (DCCP).  Behav Cogn Psychother 2011;39:165–73.
[CrossRef] | [PubMed]
 
Otto  MW;  Hinton  D;  Korbly  NB  et al.  Treatment of pharmacotherapy-refractory posttraumatic stress disorder among Cambodian refugees: a pilot study of combination treatment with cognitive-behavior therapy vs sertraline alone.  Behav Res Ther 2003;41:1271–6.
[CrossRef] | [PubMed]
 
Prasko  J;  Dockery  C;  Horacek  J  et al.  Moclobemide and cognitive behavioral therapy in the treatment of social phobia. A six-month controlled study and 24 months follow up.  Neuroendocrinol Lett 2006;27:473–81.
[PubMed]
 
Ravindran  AV;  Anisman  H;  Merali  Z  et al.  Treatment of primary dysthymia with group cognitive therapy and pharmacotherapy: clinical symptoms and functional impairments.  Am J Psychiatry 1999;156:1608–17.
[PubMed]
 
Reynolds  CF  3rd;  Miller  MD;  Pasternak  RE  et al.  Treatment of bereavement-related major depressive episodes in later life: a controlled study of acute and continuation treatment with nortriptyline and interpersonal psychotherapy.  Am J Psychiatry 1999;156:202–8.
[PubMed]
 
Rothbaum  BO;  Cahill  SP;  Foa  EB  et al.  Augmentation of sertraline with prolonged exposure in the treatment of posttraumatic stress disorder.  J Trauma Stress 2006;19:625–38.
[CrossRef] | [PubMed]
 
Shamsaei  F;  Rahimi  A;  Zarabian  MK  et al.  Efficacy of pharmacotherapy and cognitive therapy, alone and in combination in major depressive disorder.  Hong Kong J Psychiatry 2008;18:76–80.
 
Shareh  H;  Gharraee  B;  Atef-Vahid  MK  et al.  Metacognitive Therapy (MCT), fluvoxamine, and combined treatment in improving obsessive-compulsive, depressive and anxiety symptoms in patients with Obsessive-Compulsive Disorder (OCD).  Iran J Psychiatry Behav Sci 2010;4:17–25.
 
Sharp  DM;  Power  KG;  Simpson  RJ  et al.  Fluvoxamine, placebo, and cognitive behaviour therapy used alone and in combination in the treatment of panic disorder and agoraphobia.  J Anxiety Dis 1996;10:219–42.
[CrossRef]
 
Sirey  JA;  Bruce  ML;  Alexopoulos  GS.  The Treatment Initiation Program: an intervention to improve depression outcomes in older adults.  Am J Psychiatry 2005;162:184–6.
[CrossRef] | [PubMed]
 
Spinhoven  P;  Onstein  EJ;  Klinkhamer  RA  et al.  Panic management, trazodone and a combination of both in the treatment of panic disorder.  Clin Psychol Psychother 1996;3:86–92.
[CrossRef]
 
Tenneij  NH;  Megen  HJ;  Denys  DAJP  et al.  Behavior therapy augments response of patients with obsessive-compulsive disorder responding to drug treatment.  J Clin Psychiatry 2005;66:1169–75.
[CrossRef] | [PubMed]
 
Thompson  LW;  Coon  DW;  Gallagher-Thompson  D  et al.  Comparison of desipramine and cognitive/behavioral therapy in the treatment of elderly outpatients with mild-to-moderate depression.  Am J Geriatr Psychiatry 2001;9:225–40.
[CrossRef] | [PubMed]
 
van Apeldoorn  FJ;  van Hout  WJPJ;  Huisman  M  et al.  Is a combined therapy more effective than either CBT or SSRI alone? Results of a multicenter trial on panic disorder with or without agoraphobia.  Acta Psychiatr Scand 2008;17:260–70.
[CrossRef]
 
Weissman  MM;  Prusoff  BA;  Dimascio  A  et al.  The efficacy of drugs and psychotherapy in the treatment of acute depressive episodes.  Am J Psychiatry 1979;136:555–8.
[PubMed]
 
Wiborg  IM;  Dahl  AA.  Does brief dynamic psychotherapy reduce the relapse rate of panic disorder? Arch Gen Psychiatry 1996;53:689–94.
[CrossRef] | [PubMed]
 
Wiles  NJ;  Hollinghurst  S;  Mason  V  et al.  A randomized controlled trial of cognitive behavioural therapy as an adjunct to pharmacotherapy in primary care based patients with treatment resistant depression: a pilot study.  Behav Cogn Psychother 2008;36:21–33.
[CrossRef]
 
Katz  R;  Shaw  BF;  Vallis  TM  et al.  The assessment of severity and symptom patterns in depression . In: Beckham  EE;  Leber  WR (eds).  Handbook of depression , 2nd ed.  New York:  Guilford, 1995:61–85.
 
Turner  EH;  Matthews  AM;  Linardatos  E  et al.  Selective publication of antidepressant trials and its influence on apparent efficacy.  N Engl J Med 2008;358:252–60.
[CrossRef] | [PubMed]
 
Cuijpers  P;  Smit  F;  Bohlmeijer  et al.  Is the efficacy of cognitive behaviour therapy and other psychological treatments for adult depression overestimated? A meta-analytic study of publication bias.  Br J Psychiatry 2010;196:173–8.
[CrossRef] | [PubMed]
 
Friedman  MA;  Detweiler-Bedell  JB;  Leventhal  HE  et al.  Combined psychotherapy and pharmacotherapy for the treatment of major depressive disorder.  Clin Psychol Sci Pract 2004;11:47–68.
[CrossRef]
 
Otto  MW;  Smits  JAJ;  Reese  HE.  Combined psychotherapy and pharmacotherapy for mood and anxiety disorders in adults: review and analysis.  Clin Psychol Sci Pract 2005;12:72–86. DOI 10.1002/ps.20089
[CrossRef]
 
References Container
+
+

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe



Related Content
Articles
Books
The American Psychiatric Publishing Textbook of Psychopharmacology, 4th Edition > Chapter 59.  >
The American Psychiatric Publishing Textbook of Psychiatry, 5th Edition > Chapter 12.  >
Dulcan's Textbook of Child and Adolescent Psychiatry > Chapter 18.  >
Dulcan's Textbook of Child and Adolescent Psychiatry > Chapter 18.  >
Textbook of Psychotherapeutic Treatments > Chapter 13.  >
Topic Collections
Psychiatric News
APA Guidelines
PubMed Articles