Cognitive Therapy Plus Antidepressant Improves Depression Symptoms

the Psychiatry Advisor take:

Cognitive therapy (CT) combined with taking an antidepressant leads to better outcomes than taking an antidepressant alone, though the effect appears limited only to patients suffering from severe depression that is not chronic.

Steven D. Hollon, PhD, of the Department of Psychology at Vanderbilt University, Nashville, Tennessee, and colleagues examined 452 adult outpatients with chronic or recurrent major depressive disorder (MDD), who were randomly assigned to antidepressant treatment only or CT combined with an antidepressant. Treatment was administered for up to 42 weeks until recovery.

Combined treatment enhanced the rate of recovery vs. treatment with an antidepressant alone (72.6% vs 62.5%; t₄₅₁= 2.45; P=0.01; hazard ratio, 1.33; 95% C: 1.06-1.68; number needed to treat, 10; 95% CI: 5-72), the researchers reported in JAMA Psychiatry.  

However, those results were conditioned on severity and chronicity of the depression, such that the advantage for combined treatment was limited to patients with severe, nonchronic MDD (81.3% vs. 51.7%; n=146; t₁₄₅=3.96; P=0.001; HR, 2.34; 95% CI, 1.54-3.57; NNT, 3; 95% CI, 2-5).

Patients with comorbid Axis II disorders took longer to recover than did patients without comorbid Axis II disorders regardless of the condition (P=0.01). Also, patients who received combined treatment reported fewer serious adverse events than did patients who received antidepressants alone (49 vs. 71; P=0.02), largely because they experienced less time in an MDD episode.