A sequential approach to depression management that starts with medication and then transitions to psychotherapy can reduce the risk of relapse or recurrence, reports a meta-analysis in JAMA Psychiatry.
“A sequential strategy may include maintenance of antidepressant drug treatment or its discontinuation. Thus, the sequential model offers a unique opportunity for antidepressant drug tapering and discontinuation, with the advantage of yielding enduring results while limiting exposure to [antidepressant medications],” wrote Jenny Guidi, Ph.D., of the University of Bologna and Giovanni Fava, M.D., of the University of Buffalo.
Guidi and Fava compiled data from 17 studies (2,283 participants) that assessed the effects of sequential treatment on reducing depression relapse (a return of symptoms after a patient achieves remission) or recurrence (a return of symptoms after a patient achieves full recovery) in adults aged 18 to 65. For this analysis, the authors pooled relapse and recurrence into one category.
The authors focused specifically on studies in which patients were given antidepressant medication first to manage acute symptoms, followed by the addition of face-to-face psychotherapy. All the studies used some variation of cognitive therapy/cognitive-behavioral therapy as the sequential intervention, and most compared sequential psychotherapy with standard clinical care (for example, monitoring the patients and adjusting medications as necessary). The follow-up period ranged from 7 months to 10 years.
The authors found that the sequential model of care reduced the risk of depression relapse/recurrence by about 17% compared with control interventions. The risk of relapse/recurrence was similar for patients who continued antidepressants during psychotherapy or tapered and discontinued antidepressants during the psychotherapy.
For related information, see the Psychiatric News article “Combining CBT With Antidepressant Found to Be Effective Regardless of Order.”
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