Combined brief dynamic therapy and pharmacotherapy in the treatment of major depressive disorder: A pilot study

Background: The relative efficacy of supplemental psychotherapy in the treatment of depression is still a matter of debate. Moreover, the superiority of brief dynamic therapy ( BDT) over supportive psychotherapies is not well established. The aim of this study is to compare the efficacy of BDT added to medication with that of brief supportive psychotherapy ( BSP) added to medication in the treatment of major depressive disorder. Method: A 12-month randomized clinical trial compared BDT ( n = 18) with BSP ( n = 17) combined with antidepressants in outpatients with major depressive disorder. Both psychotherapies were added during the first 6 months of the trial; all patients continued to be treated with only pharmacotherapy ( paroxetine or citalopram) in the following 6-month continuation phase. Efficacy was assessed using the 17-item Hamilton Rating Scale for Depression ( HAM-D), the Hamilton Rating Scale for Anxiety and the Clinical Global Impression ( CGI). The data analysis was conducted on two samples: the per-protocol ( PP) sample and the observed-cases ( OC) sample. Results: Thirty-two patients completed the study. Although at the end of the combined therapies ( T2) no differences emerged between the two treatment approaches, the group of patients treated with BDT showed a further clinical improvement at the end of the study ( T3): a significant reduction in symptomatology emerged on the HAM-D ( PP sample: F = 75.154, p = 0.03; OC sample: F = 67.149, p = 0.022) and on the CGI total scores ( PP sample: F = 78.527, p = 0.016; OC sample: F = 74.104, p = 0.007). The difference in remission rates on the HAM-D ( 75 vs. 12.5% at T3) is statistically significant favoring BDT. Conclusions: BDT combined with antidepressants is preferable to supportive psychotherapy combined with medication in the treatment of outpatients with major depression. Copyright (c) 2007 S. Karger AG, Basel.