Keller et al5 demonstrated the superiority of combination treatment among 681 patients with chronic depression (episode exceeds 2 years). In this trial,
85% of patients treated with combined CBASP and nefazadone (CBASP+NFZ) experienced a response during acutephase treatment compared with 55% of patients treated only with NFZ and 52% of patients treated only with CBASP (P=0.001). Inhibitors,research,lifescience,medical Despite impressive response rates after 12 weeks, many patients experienced residual symptoms.5 Results from one study are less than definitive concerning the efficacy of combination treatment. Hollon et al52 compared CT and IMP as monotherapies with combined CT and IMP among 107 patients (only 64 completed the study) with major depression. They found no significant differences in acute-phase response rates and no significant differences in full remission rates, although there was a trend among individuals (who completed the study) receiving combined Inhibitors,research,lifescience,medical treatment (75%) to reach and sustain remission more frequently than individuals receiving monotherapy (50% CT, 56% IMP). For the 64 patients who completed the study, Evans et al61 report no significant differences Inhibitors,research,lifescience,medical at 2-year follow-up. Sequential treatment strategies Fava62 contends that the goal of sequential treatment strategies is to increase or boost the therapeutic effect of a first-treatment by augmenting with a second treatment. Hence, the
sequencing of treatment is dependent upon the degree of acute treatment response. Fava62 details four clinical applications of sequential treatments: (i) changing the orientation of psychotherapy when Inhibitors,research,lifescience,medical a first orientation of psychotherapy has not achieved treatment goals; (ii) introducing a second medication when the first medication has not achieve adequate symptom relief; (iii) introducing psychotherapy when medication alone has not been fully effective; and (iv) introducing Inhibitors,research,lifescience,medical medication when psychotherapy alone has not been fully effective. Only in the past decade have investigators really begun to investigate
the benefits of sequential treatment strategies. Fava and colleagues investigated a sequential approach for the treatment of residual symptoms and recurrence risk.63,64 After initial treatment with antidepressant medication, 40 patients (who demonstrated an initial, but not full those response to medication) were randomly assigned to receive 20 weeks of CBT and pharmacotherapy or clinical management and pharmacotherapy. All patients NLG919 in vitro eventually discontinued pharmacotherapy. Patients were instructed to call immediately if any new symptoms appeared and were guaranteed a renewed course of drug therapy in the event of a relapse. Fava et al17 found that the CBT group had significantly fewer residual symptoms following drug discontinuation than the clinical management group. More interestingly, the benefits of short-term CBT after successful antidepressant treatment had a substantial effect on recurrence risk.