background Many clinicians are convinced that combined therapy (psychotherapy plus antidepressants) instead of farmacotherapy (antidepressants) is the treatment of choice for ambulatory patients suffering from depression. This view, however, is not supported by empirical evidence.
aim To compare the acceptability, feasibility and efficacy of antidepressants with that of combined therapy (antidepressants plus psychotherapy) in the (ambulatory) treatment of depression.
method The study in this article is a 6-month randomised clinical trial of antidepressants (n = 84) and combined therapy (n = 83) in ambulatory patients with major depression and a 17-item HDRS(Hamilton Depression Rating Scale) baseline score of at least 14 points. The antidepressant protocol provides for three successive steps in case of intolerance or inefficacy: fluoxetine, amitriptyline and moclobemide. The combined therapy condition consists, in addition to pharmacotherapy, of 16 sessions of 'short psychodynamic supportive psychotherapy'.
results Acceptability of treatment: 32% of the patients refused after randomisation the proposed pharmacotherapy, while 13% refused the proposed combined therapy. Feasibility of treatment: in 24 weeks 40% of the patients started with the pharmacotherapy stopped medication, while 22% did so in the combined therapy condition. Efficacy of treatment: at week 24 the mean success rate was 41,2% in the pharmacotherapy group and 60,9% in the combined therapy group.
conclusion Combined therapy is preferable to pharmacotherapy in the treatment of ambulatory patients with major depression.