A new meta-analysis has concluded that combining psychotherapy with pharmacotherapy is more effective than either treatment alone in managing patients with major depression, panic disorder or obsessive-compulsive disorder (Cuijpers et al. World Psychiatry 2014;13:56-67; free full text at www.ncbi.nlm.nih.gov/pmc/articles/PMC3918025/pdf/wps0013-0056.pdf).

The analysis included 52 studies (n=3,623): 22 studies of major depression, 5 of dysthymia, 5 of mixed mood disorders, 10 of panic disorder, 4 of OCD (including 1 with depression), 4 of social anxiety disorder (SAD), 2 on post-traumatic stress disorder and 1 on generalized anxiety disorder. Drug therapies included SSRIs (n=22), tricyclic antidepressants (n=13), SNRIs (n=3), MAO inhibitors (n=4) or a variety of other treatments (n=10). Most used some form of cognitive and behavioural therapy, most commonly involving 10-20 sessions.

The overall mean effect size of drug therapy alone versus combined pharmacotherapy + psychotherapy was 0.43 in favour of the combination approach; the number needed to treat (NNT) was 4.20. Effect sizes were greatest for OCD (NNT 2.63) and panic disorder (NNT 3.36). There was insufficient evidence with respect to dysthymia, PTSD and GAD. The dropout rate was comparable with combined treatment and drug treatment alone.

In examining either therapy alone and combined treatment versus placebo, the analysis found that the effects of psychotherapy and pharmacotherapy were largely independent of one another, with each contributing about 50% of the total treatment effect. Thus, there appears to be an additive benefit when a combination therapy approach is used.

The authors concluded that drug treatment alone may not be the optimal management of patients with depression or anxiety disorders.