Evidence-Based Psychotherapy and Psychopharmacology for Mood Disorders: A Conversation With Holly A. Swartz, MD

BRAIN TRUST: CONVERSATIONS IN PSYCHOPHARMACOLOGY

-Series Editor Joseph F. Goldberg, MD

Joseph F. Goldberg, MD, in this installment of "Brain Trust: Conversations in Psychopharmacology," sits down with Holly A. Swartz, MD, to discuss evidence-based psychotherapies for mood disorders, emphasizing a nuanced approach to treating depression.

If a patient prefers to start with psychotherapy, they should be given 6 to 12 weeks to see if it works before considering augmentation or switching to another modality, shared Swartz. The approach is similar to starting pharmacotherapy and considering augmentation or switching if there is no response.

For less severe depression, Swartz recommends utilizing psychotherapies like cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT), as they are comparable to pharmacotherapy.

For patients with severe depression, Swartz finds combining psychotherapy with antidepressants to be more effective; however, patients with severe depression alongside cognitive rigidity and melancholia may benefit more from pharmacotherapy, whereas patients with moderate depression and interpersonal or cognitive issues may benefit more from CBT or IPT.

"The way that I think about it is you have got to have stuff to work with in order for the treatments to be effective. We have seen that differential response to IPT and CPT," said Swartz.

Additionally, patient preference significantly impacts treatment success, with those receiving their preferred treatment being 4 times more likely to respond.¹

"Getting what you think is going to help you feel better, get better actually matters a lot," said Swartz.

The conversation also explores the integration of psychodynamic principles in pharmacotherapy, the role of psychotherapy in neuroplasticity, and the concept of deprescribing in psychotherapy.²

"We always want to tailor our treatments for the individual. Some people might feel that they need a little bit less because they really get it, and they are able to use other coping strategies, whereas there may be others who struggle a bit more and need more frequent help. Our modal frequency would be monthly, with the capacity to flex that based on on patient needs and tailored treatments," concluded Swartz.

Dr Goldberg is a clinical professor of psychiatry at The Icahn School of Medicine at Mount Sinai in New York, NY and the immediate-past president of the American Society of Clinical Psychopharmacology.

Dr Swartz is a professor of psychiatry and the director of the Center for Advanced Psychotherapy at the University of Pittsburgh School of Medicine.

References

1. Swartz HA, Rucci P, Thase ME, et al. Psychotherapy alone and combined with medication as treatments for bipolar II depression: a randomized controlled trial. J Clin Psychiatry. 2018;79(2):16m11027.

2. Goldberg JF. Deprescribing: does the term belong in the psychiatric lexicon? Psychiatric Times. 2025;42(5).