Combining psychopharmacotherapy and psychotherapy is not associated with better treatment outcome in major depressive disorder - evidence from the European Group for the Study of Resistant Depression

Lucie Bartova,Gernot Fugger,Markus Dold,Marleen Margret Mignon Swoboda,Joseph Zohar,Julien Mendlewicz,Daniel Souery,Stuart Montgomery,Chiara Fabbri,Alessandro Serretti,Siegfried Kasper

doi:10.1016/j.jpsychires.2021.06.028

Abstract

Despite plenty of effective antidepressant (AD) treatments, the outcome of major depressive disorder (MDD) is often unsatisfactory, probably due to improvable exploitation of available therapies. This European, cross-sectional, naturalistic multicenter study investigated the frequency of additional psychotherapy in terms of a manual-driven psychotherapy (MDP) in 1410 adult in- and outpatients with MDD, who were primarily treated with AD psychopharmacotherapy. Socio-demographic and clinical patterns were compared between patients receiving both treatments and those lacking concomitant MDP. In a total of 1279 MDD patients (90.7%) with known status of additional MDP, those undergoing a psychopharmacotherapy-MDP combination (31.2%) were younger, higher educated, more often employed and less severely ill with lower odds for suicidality as compared to patients receiving exclusively psychopharmacotherapy (68.8%). They experienced an earlier mean age of MDD onset, melancholic features, comorbid asthma and migraine and received lower daily doses of their first-line ADs. While agomelatine was more often established in these patients, MDD patients without MDP received selective serotonin reuptake inhibitors more frequently. These two patient groups did not differ in terms of response, non-response and treatment resistant depression (TRD). Accordingly, the employment of additional MDP could not be related to better treatment outcomes in MDD. The fact that MDP was applied in a minority of patients with rather beneficial socio-demographic and clinical characteristics might reflect inferior accessibility of these psychotherapeutic techniques for socially and economically disadvantaged populations.

Highlights

The enormous global societal and economic burden of major depressive disorder (MDD) (Vos, Allen C et al, 2016) is underlined by the fact that the incidence of MDD has doubled within the last three decades (Liu et al, 2020) leading to 322 million individuals suffering from this disorder in 2015 (WHO 2007)
With respect to severity of depressive symptoms, the present study revealed overall lower scores regarding the Hamilton Rating Scale for Depression (HAM-D) and the Montgomery and Åsberg Depression Rating Scale (MADRS) as well as a lower degree of suicidal risk in MDD patients treated with a psychopharmacotherapy-manual-driven psychotherapy (MDP) combination as compared to those receiving exclusively psychopharmacotherapy
The abovementioned cross-sectional and retrospective analyses revealed that merely about one-third of the present naturalistic sample of MDD patients was treated by a psychopharmacotherapy-MDP com bination, which is in contrast to most available treatment recommen dations

Summary

Introduction

The enormous global societal and economic burden of major depressive disorder (MDD) (Vos, Allen C et al, 2016) is underlined by the fact that the incidence of MDD has doubled within the last three decades (Liu et al, 2020) leading to 322 million individuals suffering from this disorder in 2015 (WHO 2007). The most obvious approach to counteract outcome deficiencies might be a systematic and individualized exploitation of available treatment options, ideally in the course of recommended treatment algorithms (Bartova et al, 2019; Kraus et al, 2019). Further evidence suggests that effect sizes of the various PT-types conducted in terms of MDP, whereby the cognitive behavioral therapy (CBT) currently repre sents the best and the most investigated school of thought, are in the range of AD psychopharmacotherapy (Cuijpers et al, 2014). It is noticeable in this context that current clinical practice guidelines (CPGs) derived from different continents and societies lack consistency with respect to recommendations of the multifaceted treatment options available for MDD, especially in terms of MDP (Bayes and Parker 2018). We aimed to elucidate associations between the employment of additional MDP and treatment outcome in a large naturalistic sample of MDD pa tients across different European countries

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