Combined Treatment vs Monotherapy for Major Depressive Disorder

Ron Pies, MD, shared enthusiasm about integrating biological and psychosocial approaches to psychiatric treatment, noting that research in this area continues to evolve. For major depressive disorder, Pies said the most effective treatment often combines a somatic component, such as medication, with a psychosocial component, such as psychotherapy, and that the 2 tend to work synergistically.¹ He said neurovegetative features of major depression—insomnia, loss of appetite, weight loss—typically respond to medication, while more psychic aspects of the disorder respond to psychotherapy. As Pies put it, "the more psychic aspects like guilt, low self-esteem, those respond to psychotherapy and the 2 together probably for many patients work better than either alone."

Pies described a long-standing opposition to reductionistic treatment models for any psychiatric disorder, particularly depressive disorders. He pointed to ongoing research examining how psychotherapy and medication should be sequenced in patients with severe major depression—whether treatment should begin simultaneously or with one modality before the other—describing these as open questions still being worked out.

Pies said psychiatry faces a substantial task in public outreach, arguing that the field could do more to explain what it does, how, and why, to bring the public "into the fold." He said, "there is a gap there between what we know about ourselves as a profession and how we're perceived by many in the general public."² Pies connected this gap to recent campaigns against antidepressants and other psychiatric medications, saying such campaigns often raise legitimate concerns but are also accompanied by substantial misinformation about these agents. He said the field needs to do a better job reaching out to and meeting with the general public, explaining the rationale behind psychiatric treatment and why clinicians believe it can help.

Dr Pies is editor-in-chief emeritus of Psychiatric Times and professor emeritus of psychiatry at SUNY Upstate Medical University.

References

1. Cuijpers P, Sijbrandij M, Koole SL, et al. Adding psychotherapy to antidepressant medication in depression and anxiety disorders: a meta-analysis. World Psychiatry. 2014;13(1):56-67.

2. Fountoulakis KN, Hoschl C, Kasper S, et al. The media and intellectuals' response to medical publications: the antidepressants' case. Ann Gen Psychiatry. 2013;12:11.