Adherence to antidepressant medication use is a problem in clinical
practice. Some authors have posited that combined psychological treatment
facilitates adherence to pharmacotherapy.
To study the relationship between adherence to use of and efficacy of
antidepressant drugs plus psychological treatment vs drug treatment alone
in depressive disorders.
MEDLINE, Current Contents, PsychInfo, Cochrane Library, and reference
lists were searched, from January 1980 to November 2002.
Randomized clinical trials comparing antidepressant treatment alone
with antidepressant treatment in combination with a psychological intervention
in depressive disorders were considered. The decision to include studies in
the meta-analysis was performed by 2 reviewers.
Three independent reviewers extracted the data, using a precoded form.
Methodological quality of the studies was evaluated in terms of allocation
concealment and independence of evaluators.
Sixteen trials met the inclusion criteria, with 932 patients randomized
to pharmacotherapy alone and 910 to combined treatment. Overall, patients
receiving combined treatment improved significantly compared with those receiving
drug treatment alone (odds ratio [OR], 1.86; 95% confidence interval [CI],
1.38-2.52), but dropouts and nonresponders did not differ in distribution
between the 2 treatment modalities (OR, 0.86; 95% CI, 0.60-1.24). Studies
longer than 12 weeks showed a significant advantage of combined treatment
over drug treatment alone (OR, 2.21; 95% CI, 1.22-4.03), with a significant
reduction in dropouts compared with nonresponders (OR, 0.59; 95% CI, 0.39-0.88).
These estimates were not affected by study quality.
Psychological treatment combined with antidepressant therapy is associated
with a higher improvement rate than drug treatment alone. In longer therapies,
the addition of psychotherapy helps to keep patients in treatment. Further
studies are needed to investigate whether the improvement in response attributable
to the combination of drug treatment and psychotherapy can be achieved by
a combination of pharmacotherapy and a compliance-enhancing intervention.