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Sequential use of pharmacotherapy and psychotherapy reduces rates of relapse or recurrence in patients with major depressive disorder

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How effective is sequential use of psychotherapy following pharmacotherapy in adults with major depressive disorder (MDD)?


Primary outcome: rates or recurrence of MDD symptoms (according to different diagnostic measures).



Systematic review and meta-analysis.

Data sources

MEDLINE, EMBASE, PsycINFO, Cochrane Library up to December 2008; hand searching of bibliographies; direct contact with selected experts to identify studies. The search strategy was broad, and terms included drugs and psychotherapy, sequential treatment, combined treatment, continuation or maintenance, relapse or recurrence and prevention, depress* or major depress*.

Study selection and analysis

Randomised controlled trials (RCTs) of psychotherapy in patients with successful response to acute-phase pharmacology. Study selection was limited to trials in adults with MDD. Studies were excluded if the psychotherapy was not delivered face to face, the outcome was not coded categorically, the participants were under 18 or the study group was focused exclusively on patients with non-MDD depressive conditions (eg, bipolar disorder) or which included or focused exclusively on patients with a …

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  • Sources of funding MF and GIP have received funding from a number of pharmaceutical companies.


  • Competing interests None.

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