A everyday issue in the treatment ...

A everyday issue in the treatment of patients with depression is compliance with antidepressant physic regimens. Dropout rates from clinical trials are as to a great degree as 33 percent, regardless of the put drugs into class being evaluated. Still, the vast majority of clinical trials for depression use an assessment of depression as the solely outcome measure and do not provide any information about adherence to medication regimens. Psychologic treatment is used in addition to medications to improve consequences in patients with depression. The combination of psychologic treatment with medication may have one added benefit in improving adherence to pharmacotherapy. Pampallona and colleagues performed a systematic review of randomized clinical trials that evaluated pharmacotherapy versus com-bined treatment with pharmacotherapy and psychotherapy in patients with depression.

The authors performed a literature search in multiple databases to find randomized clinical trials that assessed the use of pharmacotherapy in single treatment arm versus combined pharmacotherapy and psychotherapy in the treatment of patients with depression. They also reviewed clinical guidelines and relation lists of published articles to determine if any additional studies should be included in the review. Data extracted from the studies were diagnosis, sex mean age of the application of mind sample, antidepressant drug administered, duration of the thought type of combined treatment, the number of patients with satiated response, the number with partial or no reply and the number that dropp on the outside of the study. The antidepressant dosage was changeed to milligram equivalents of imipramine hydrochloride using a published conversion chart. The quality of the methodology of each cogitation also was evaluated.

There were 16 trials that met the inclusion criteria. The total number of patients recorded in antidepressant therapy alone was 932 and 910 patients were enlisted in the combination portion of the studies. Patients in the combined treatment arms improved significantly compared with those receiv-ing pharmacotherapy alone. No significant differences were noted in dropout and non-responder rates between the sum of two units treatment arms. When assessing dropout and non-responders in trials that lasted more than 12 weeks, there was a significant benefit with combined therapy. Assessing the quality of the close attention had no impact on these variables.

The authors deduce that the combination of pharmacotherapy and psychotherapy provides a better improvement rate in patients with depression than pharmacotherapy alone. They add that in longer studies, psychotherapy helped preserve patients in treatment. They note that further studies should be performed to determine if this improvement with combined therapy can be matched with pharmacotherapy combined with a compliance-enhancement program.

Pampallona s et al. Combined pharmacotherapy and psychological treatment for depression. A systematic review. Arch Gen Psychiatry July 2004;61:714-9

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