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Sequential Combination of Pharmacotherapy and Psychotherapy in Major Depressive Disorder

The sequential model emerged from the awareness that the persistence of residual symptoms and the frequent occurrence of psychiatric comorbidity were both associated with poor long-term outcome of major depressive disorder (MDD).

The study aimed to examine the association of the sequential combination of pharmacotherapy and psychotherapy with reduced risk of relapse and recurrence in MDD. Keyword searches were conducted in PubMed, PsycInfo, Web of Science, and the Cochrane Library from inception of each database through November 2019. Randomized clinical trials examining the effectiveness of the sequential use of psychotherapy following response to acute-phase pharmacotherapy in the treatment of adult remitted patients with MDD were selected independently by 2 reviewers.

Seventeen randomized clinical trials met criteria for inclusion in the meta-analysis, with 1 study yielding 2 comparisons (2283 patients overall, with 1208 patients in a sequential treatment arm and 1075 in a control arm). The pooled risk ratio for relapse/recurrence of MDD was 0.84 (95% CI, 0.74-0.94), suggesting a relative advantage in preventing relapse/recurrence for the sequential combination of treatments compared with control conditions. The results of this systematic review and meta-analysis indicate that the sequential integration of psychotherapy following response to acute-phase pharmacotherapy, alone or combined with antidepressant medication, was associated with reduced risk of relapse and recurrence in MDD. The preventive value of the sequential strategy relies on abatement of residual symptoms and/or increase in psychological well-being. The steps for implementing the sequential approach in remitted patients with recurrent MDD are provided.

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The psychological impact of medications

Clinical pharmacopsychology consists of the application of clinical psychology to the full understanding of
pharmacological effects. Clinical pharmacopsychology encompasses clinical benefits of psychotropic drugs as well as vulnerabilities induced by treatment (side effects, behavioral toxicity, iatrogenic comorbidity) and the interactions between drug treatment and psychological variables such as quality of life and psychological well-being. To know more about clinical pharmacopsychology read the full article on Psychotherapy and Psychosomatic.

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Current Psychosomatic Practice: the relevance of well-being

Psychosomatic research has advanced over the past decades in dealing with complex biopsychosocial phenomena
and may provide new effective modalities of patient care.  Among psychosocial variables affecting individual vulnerability, course, and outcome of any medical disease, the role of chronic stress (allostatic overload) and well-being have emerged as a crucial factors.

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What the pursuit of well-being means to our brain

In the current issue of Psychotherapy and Psychosomatics, Gregor Hasler (University of Bern) analyzes the neuroscientific implications of the pursuit of well-being. Promising findings show strong and lasting effects of currently available well-being therapy in severe psychiatric conditions such as major depressive disorder. This work encourages physicians to implement positive health promotion right now into clinical work. The Author is confident that current clinical insights and experiences along with a neurobiological understanding of positive health will provide us with novel and more effective well-being therapy options.

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