Combined Treatments for Depression

There are optimal practices to integrate drug and nondrug treatments for depression. The following points can facilitate understanding of the goals and procedure for this combined treatment.

1. Psychotherapy should be considered for all patients being evaluated for antidepressant medication, either as an alternative to medication or as an augmenting tool.
2. “Watchful waiting” works: A period of evaluation and symptom exploration prior to the prescription of a medication can help confirm diagnosis and treatment options.
3. A careful history is essential prior to starting an antidepressant. Past histories of response to medication(s) or psychotherapy often dictate best options.
4. Patients started on medication should be afforded a course of psychotherapy. CBT and Interpersonal Therapy have the largest evidence base.
5. Clinicians should establish in advance a list of target symptoms for medication (e.g., energy levels, appetite, sleep patterns) and target symptoms for psychotherapy (e.g., despair/hopelessness, suicidal ideation, distorted cognitions, social withdrawal).
6. These target symptoms should comprise elements of informed consent and should be charted throughout the treatment course to determine response to treatment and outcome goals.
7. The response to medication is often more rapid than response to psychotherapy; psychotherapeutic effects often tend to persist after active treatment ends.
8. For patients with new onset depression, remission (return to a depression-free state) is the overall target. For patients with chronic, relapsing depression, response to an agreed on set of key symptoms is often the target.
9. Non-prescribing psychologists should make arrangements with prescribers in advance to coordinate care at critical points: Periods when medication is initiated and discontinued often require more intensive monitoring or intervention.
10. Treatment adherence is highest when patients receive the treatment they prefer, so accurate informed consent is essential.

Sammons, M. T. (Presenter), & National Register of Health Service Psychologists (Producer). (2018, July). Combined treatments for depression: Evidence and interventions [Webinar].