Bridging the Gap: Combining Somatic and Psychological Interventions

Abstract

The prediction of the World Health Organization that, by 2020, major depression will be second only to ischemic heart disease as a cause of disability highlights the importance of pursuing novel treatment approaches to this intractable psychiatric problem. In their article in Biological Psychiatry, Brakemeier et al. (1) illustrate the implementation of one novel approach by using talk therapy to prolong the robust but shortlived antidepressant effects of a somatic therapy for severe depression. Although research efforts regarding pharmacologic and psychotherapeutic approaches have recently been attracting growing attention, far less attention has been paid to combining treatment modalities to achieve a synergistic effect. Electroconvulsive therapy (ECT) is an effective and rapidly acting treatment of severe major depressive disorder with initial success rates commonly reported in the range of 60%–90% (2). However, relapse rates are notoriously high, and the field continues to strive for evidenced-based guidelines to sustain the antidepressant effect of ECT. To date, recommendations for immediate follow-up care have focused exclusively on continued medication, timing and combination of medications, and various schedules of continuation and maintenance ECT. Thinking outside the proverbial “somatic” box, Brakemeier et al. note that cognitive-behavioral therapy (CBT) has an evidenced-based reputation for sustaining antidepressant response. In the treatment of acute depression, CBT is as effective as antidepressant medication, and evidence exists for its prophylactic effects in reducing relapse in chronic depression (3). Studies have shown that CBT and related talk therapies can be beneficial to depressed patients who show only a partial response to medication (4) and when