Treatment of Major Depression With Psychotherapy or Psychotherapy-Pharmacotherapy Combinations
Archives of General PsychiatryPublished 1 November 1997
Michael E. Thase
Citations509
Generate an AI Snapshot to get a quick, structured summary of this paper.
Study Snapshot
ObjectiveStudy objective
MethodsResearch methodology
PopulationPopulation studied
Sample sizeSample sizes
OutcomesStudy outcomes here
ResultsStudy results comes here
LimitationsResearch study limitations comes here
A concise AI-generated summary of the paper will appear here once you click Generate AI Snapshot.
TL;DR
New evidence is found in support of the widespread clinical impression that combined therapy is superior to psychotherapy alone for treatment of more severe, recurrent depressions.
Abstract
Mega-analysis is a powerful method for comparing the efficacy of treatments and examining correlates of response. Using this method, we found new evidence in support of the widespread clinical impression that combined therapy is superior to psychotherapy alone for treatment of more severe, recurrent depressions.
Keywords
PsychologyMedicine
Archives of General PsychiatryAn Inventory for Measuring Depression
38,163 Citations1961Aaron T. Beck
The difficulties inherent in obtaining consistent and adequate diagnoses for the purposes of research and therapy have been pointed out and a wide variety of psychiatric rating scales have been developed.
Journal of Neurology Neurosurgery & PsychiatryA RATING SCALE FOR DEPRESSION
32,633 Citations1960M. Hamilton
The present scale has been devised for use only on patients already diagnosed as suffering from affective disorder of depressive type, used for quantifying the results of an interview, and its value depends entirely on the skill of the interviewer in eliciting the necessary information.
Archives of General PsychiatryResearch Diagnostic Criteria
6,963 Citations1978Robert L. Spitzer
The development and initial reliability studies of a set of specific diagnostic criteria for a selected group of functional psychiatric disorders, the Research Diagnostic Criteria (RDC), indicate high reliability for diagnostic judgments made using these criteria.
Analysis of Survival Data
5,999 Citations2018D. R. Cox, David Oakes
Archives of General PsychiatryA Diagnostic Interview
5,709 Citations1978Jean Endicott
Initial scale development and reliability studies of the items and the scale scores are reported on.
Archives of General PsychiatryThe Global Assessment Scale
4,952 Citations1976Jean Endicott
The relative simplicity, reliability, and validity of the GAS suggests that it would be useful in a wide variety of clinical and research settings.
Archives of General PsychiatryNational Institute of Mental Health Treatment of Depression Collaborative Research Program
2,324 Citations1989Irene Elkin
There was limited evidence of the specific effectiveness of interpersonal psychotherapy and none for cognitive behavior therapy, but Superior recovery rates were found for both interpersonal Psychotherapy and imipramine plusclinical management, as compared with placebo plus clinical management.
American PsychologistMeta-analysis of psychotherapy outcome studies.
2,110 Citations1977Mary Lee Smith, Gene V. Glass
Results of nearly 400 controlled evalua- tions of psychotherapy and counseling were coded and integrated statistically and provide convincing evidence of the efficacy of psych therapy.
Archives of General PsychiatryConceptualization and Rationale for Consensus Definitions of Terms in Major Depressive Disorder
1,940 Citations1991Ellen Frank
It is concluded that research on depressive illness would be well served by greater consistency in the definition change points in the course of illness, and proposes an internally consistent, empirically defined conceptual scheme for the terms remission, recovery, relapse, and recurrence.
Archives of General PsychiatryThree-Year Outcomes for Maintenance Therapies in Recurrent Depression
1,309 Citations1990David J. Kupfer
It is concluded that active imipramine treatment is an effective means of preventing recurrence beyond 3 years and that patients with previous episodes less than 2 1/2 years apart, therefore, merit continued prophylaxis for at least 5 years.
Medical Entomology and ZoologyInterpersonal Psychotherapy Of Depression
1,170 Citations1984Gerald L. Klerman
The British Journal of PsychiatryThe Efficacy of Cognitive Therapy in Depression: A Treatment Trial Using Cognitive Therapy and Pharmacotherapy, each Alone and in Combination
560 Citations1981I. M. Blackburn, S. Bishop +3 more
An extensive study which compares cognitive therapy, antidepressant drugs and a combination of these two, in depressed patients seen either in general practice or an out-patient department and results are discussed in terms of Beck's cognitive theory of depression.
Archives of General PsychiatryCognitive Therapy and Pharmacotherapy for Depression
468 Citations1992Steven D. Hollon
Combining cognitive therapy with pharmacotherapy did not markedly improve response over that observed for either modality alone, although such nonsignificant differences as were evident did favor the combined treatment.
Archives of General PsychiatryCognitive Therapy and Pharmacotherapy
440 Citations1984George E. Murphy
BMJFluoxetine and suicide: a meta-analysis of controlled trials of treatment for depression.
363 Citations1991Charles M. Beasley, Bruce E. Dornseif +7 more
Data from these trials do not show that fluoxetine is associated with an increased risk of suicidal acts or emergence of substantial suicidal thoughts among depressed patients.
Archives of General PsychiatryPredictors of Drug Response in Depression
282 Citations1989Peter R. Joyce
Clinical and biologic predictors of response, despite some interesting leads that may in the long term be of considerable importance, are not yet sufficiently established to be of routine clinical usefulness, although either dexamethasone nonsuppression or a shortened rapid eye movement latency may identify depressed patients who require biologic treatment.
Statistics in MedicineMeta‐analysis of clinical trials as a scientific discipline. I: Control of bias and comparison with large co‐operative trials
244 Citations1987Thomas C. Chalmers, Howard R. Levin +4 more
Meta-analysis is an important method of bridging the gap between undersized randomized control trials and the treatment of patients, but the opportunities for bias to distort the results are widespread and attempts must be made to introduce the controls found in prospective studies.
Archives of General PsychiatryFactors Associated With 1-Year Outcome of Major Depression in the Community
209 Citations1990Jack Sargeant
A high rate of nonrecovery was confirmed, with clinical features associated with a poor outcome that resembled those identified in previous clinical studies, and clinical factors were more important prognostically than were sociodemographic characteristics.
Archives of General PsychiatryCombined Psychotherapy and Pharmacotherapy for Depression
205 Citations1986Hope R. Conte
A new statistical approach is developed that is specific in its method of evaluating the quality of each study and specific about the weights given to each outcome in order to determine whether combined psychotherapy and pharmacotherapy is superior to alternative therapies for unipolar depression.
The Psychological Treatment of Depression
192 Citations2010J. Mark G. Williams
American PsychologistPsychotherapy outcome studies do not accurately represent current models of psychotherapy: A proposed remedy.
187 Citations1991Jacqueline B. Persons
Archives of General PsychiatryThe Psychological Treatment of Depression
185 Citations1979Myrna M. Weissman
The British Journal of PsychiatryColumbia Atypical Depression
174 Citations1993F M Quitkin, Jonathan W. Stewart +7 more
It is concluded that the researcher and the clinician should consider the relevance of the atypical depressive syndrome in patients with reactive mood meeting DSM-III criteria for depressive illness.
American Journal of PsychiatryCombined pharmacotherapy and psychotherapy in the acute and continuation treatment of elderly patients with recurrent major depression: a preliminary report
161 Citations1992Charles F. Reynolds, Ellen Frank +8 more
Use of nortriptyline plus interpersonal psychotherapy for 9.1 weeks (median) of acute and 16 weeks of continuation therapy appears to be associated with good response and relatively low attrition but about a 25% chance of relapse during double-blind discontinuation of nortripyline.
The British Journal of PsychiatryHow Long Should the Elderly Take Antidepressants?
156 Citations1993Old Age Depression Interest Group, Robin Jacoby +31 more
It is suggested that elderly persons who recover from a major depressive illness should continue with antidepressant medication for at least two years, if not indefinitely.
American Journal of PsychiatryTreatment outcome in recurrent major depression: a post hoc comparison of elderly ("young old") and midlife patients
151 Citations1996Charles F. Reynolds, E Frank +5 more
Older patients appear to benefit as much as, but perhaps more slowly then, midlife patients from treatment of major depression, and Continuation treatment should be vigorous and closely monitored, given the apparently higher relapse rates among the elderly.
Behavior TherapyEffects of social skill training, amitriptyline, and psychotherapy in unipolar depressed women
151 Citations1984Michel Hersen, Jonathan M. Himmelhoch +2 more
Archives of General PsychiatryThe Role of Psychotherapy in the Treatment of Depression
122 Citations1996Jacqueline B. Persons
Both guidelines understate the value of psychotherapy alone in the treatment of more severely depressed outpatients and the APA guideline overvalues the role of combined psychotherapy-pharmacotherapy regimens, particularly in view of the greater cost of this strategy.
American Journal of PsychiatryCognitive-behavioral treatment of depressed inpatients: six- and twelve- month follow-up
121 Citations1989Ivan W. Miller, William H. Norman +1 more
Significantly higher proportions of the patients who received additional cognitive-behavioral treatment (cognitive therapy or social skills) had responded by the end of the formal treatment period and did not relapse for the remainder of the 1-year follow-up period.
Archives of General PsychiatrySexual Function in Depressed Men
98 Citations1993Eric A. Nofzinger
Nocturnal penile tumescence alterations in depression may be similar to other persistent electroencephalographic sleep abnormalities seen in depressed patients in remission, in being more trait-like than statelike.
NeuropsychopharmacologyReanalysis of The National Institute of Mental Health Treatment of Depression Collaborative Research Program General Effectiveness Report
78 Citations1993Donald F. Klein, Donald C. Ross
Reanalysis of the NIMH Treatment of Depression Collaborative Research Program General Effectiveness Report statistical analyses indicates a reasonable ordering for the treatments with medication superior to the psychotherapies and the psychotherapy somewhat superior to placebo.
Journal of Consulting and Clinical PsychologyAn introduction to survival analysis: Statistical methods for analysis of clinical trial data.
71 Citations1989Joel B. Greenhouse, Dalene Stangl +1 more
This article introduces statistical methods for evaluating differences in the patterns of time to response between two groups of subjects to determine whether one therapy is better than another and illustrates two elementary methods for analyzing survival data.
Journal of Consulting and Clinical PsychologyProspects for future comparisons between drugs and psychotherapy: Lessons from the CBT-versus-pharmacotherapy exchange.
67 Citations1996Neil S. Jacobson, Steven D. Hollon
It is concluded that controlling for allegiance within site is the optimal strategy, that measures of competence must take context into account, and that pill placebo controls are optimal but not essential to comparisons between CBT and pharmacotherapy.
Psychiatric AnnalsRefractory Depression: Relevance of Psychosocial Factors and Therapies
64 Citations1994Michael E. Thase, Robert H. Howland
Behavior TherapyDexamethasone suppression test and response to cognitive therapy and antidepressant medication
62 Citations1992Dennis L. McKnight, Rosemery O. Nelson‐Gray +1 more
The DST did not predict differential treatment responsiveness, with both groups of subjects improving with either cognitive therapy or tricyclics, and the DST was useful prognostically in that depressives with an abnormal DST had a poorer response to either treatment.
Comprehensive PsychiatryTraining therapists to perform interpersonal psychotherapy in clinical trials
61 Citations1986Bruce J. Rounsaville, Eve S. Chevron +3 more
While more extensive casework appeared to improve the performance of those with lower initial ratings, those with high initial ratings may not require prolonged training to perform this form of psychotherapy in clinical trials.
Psychiatry ResearchElectroencephalographic sleep studies in depressed outpatients treated with interpersonal psychotherapy: II. Longitudinal studies at baseline and recovery
53 Citations1992Daniel J. Buysse, David J. Kupfer +3 more
The hypothesis that most visually scored EEG sleep measures are stable through the acute episode of depression, at least into early symptomatic remission is supported and it is suggested that finer-grained automated analyses of delta and REM activity may provide more sensitive tools for examining state-related changes.
Journal of Consulting and Clinical PsychologyBiological markers, treatment outcome, and 1-year follow-up in endogenous depression: Electroencephalographic sleep studies and response to cognitive therapy.
43 Citations1992Anne D. Simons, Michael E. Thase
Overall, there was little support for the prediction of a difference in short- or long-term outcome between patients with and without EEG sleep disturbances.
The British Journal of PsychiatryClassification of Depression and Response to Antidepressive Therapies
40 Citations1983Mohammed T. Abou‐Saleh, Alec Coppen
Patients with Newcastle scores in the middle range showed significantly higher percentage improvement than those with low (0–3) and high (9–12) scores and it is suggested that these differences in response to antidepressant therapies reflect the heterogeneity of depressive illness.
Behaviour Research and TherapySeverity of unipolar depression and choice of treatment
31 Citations1992Peter D. McLean, Steven Taylor
It is concluded that this failure to replicate the NIMH trial findings can not be attributed to treatment differences, populations or statistical power, and the suggestion that pharmacotherapy be the treatment of choice for more severely depressed outpatients appears to be unjustified on the basis of available evidence.
Behavior TherapyCognitive behavior therapy of endogenous depression: Part 1: An outpatient clinical replication series
29 Citations1991Michael E. Thase, Anne D. Simons +2 more
Journal of Clinical PsychopharmacologyAge As a Predictor of Treatment Response in Endogenous Depression
17 Citations1983Richard P. Brown, John A. Sweeney +3 more
Psychiatric Clinics of North AmericaPsychotherapies and Somatic Therapies in Affective Disorders
13 Citations1983Gerald L. Klerman
The scientific issues in evaluating the psychotherapies, vis-a-vis somatic therapies, as well as the special problems in assessing the efficacy of combined treatments are reviewed.
