Effectiveness of combined psychotherapy and pharmacotherapy in the treatment of major depressive disorder: An integrative literature review
DOI:
https://doi.org/10.33448/rsd-v15i5.51057Keywords:
Psychotherapy, Mental Health, Combined Therapy, Major Depressive Disorder.Abstract
Depression is one of the most prevalent mental disorders worldwide and is associated with significant impairment in quality of life. Major depressive disorder (MDD) is characterized by recurrent and disabling episodes and may be treated with pharmacotherapy, psychotherapy, or a combination of both. The aim of this study was to evaluate the effectiveness of combining psychotherapy and pharmacotherapy in the treatment of MDD, comparing its effects with isolated interventions. This study consisted of an integrative literature review conducted using the MedLine and SciELO databases, including studies published within the last 25 years in Portuguese and English. Study selection was performed by two independent reviewers, and methodological quality was assessed using the Jadad scale and the AMSTAR 2 tool. A total of 16 studies were included, comprising 9 systematic reviews and 7 randomized clinical trials. The results indicated that combined therapy provided relevant clinical benefits, particularly in reducing recurrence and maintaining remission. However, some studies did not demonstrate significant superiority over isolated approaches. It was concluded that the combination of psychotherapy and pharmacotherapy represents a promising strategy in the treatment of MDD, although study heterogeneity limits definitive conclusions.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Association.
Bota, R. G., et al. (2016). Mindfulness-based cognitive therapy in recurrent major depressive disorder: Long-term outcomes. Journal of Affective Disorders, 200, 45–52.
Brasil. Ministério da Saúde. (2012). Saúde mental: protocolos clínicos e diretrizes terapêuticas. Ministério da Saúde.
Breuer, L., Czaplicki, A., Hegerl, U., & Reich, H. (2025). Utilization of psychotherapy, pharmacotherapy, and their combination by individuals with current or residual depression: Results from five annual nationally representative German surveys. Scientific Reports, 15, 43876.
Cho, H. J., Lee, H. J., Lee, M. S., et al. (2016). Comparative effectiveness of antidepressant medication versus cognitive behavioral therapy. Depression and Anxiety, 33(8), 742–750.
Ci, J.-z., Guo, Z.-b., Lin, N.-y., Zhang, H.-z., & Lin, L.-h. (2026). Efficacy differences of acute-phase strategies for adult depression: A comprehensive network meta-analysis based on evidence from 2019 to 2024. Journal of Affective Disorders, 405, 121545.
Costa, A. L. (2005). Psicoterapia psicodramática no transtorno depressivo maior. Revista Brasileira de Psiquiatria, 27(2), 120–126.
Cuijpers, P., van Straten, A., Andersson, G., & van Oppen, P. (2013). Psychotherapy for depression in adults: A meta-analysis of comparative outcome studies. World Psychiatry, 12(2), 137–148.
Fournier, J. C., DeRubeis, R. J., Hollon, S. D., Dimidjian, S., Amsterdam, J. D., Shelton, R. C., et al. (2008). Antidepressant drug effects and depression severity. JAMA, 303(1), 47–53.
Furukawa, T. A., Cipriani, A., Cowen, P. J., Leucht, S., Egger, M., & Salanti, G. (2021). Optimal treatment strategies for depression: A network meta-analysis. The Lancet Psychiatry, 8(4), 293–305.
Gartlehner, G., Gaynes, B. N., Amick, H. R., Asher, G. N., Morgan, L. C., Coker-Schwimmer, E., et al. (2023). Comparative benefits and harms of antidepressant, psychological, complementary, and exercise treatments for major depression. Annals of Internal Medicine, 176(3), 381–392.
Jonsson, U., Alaie, I., Löfgren Wilteus, A., Zander, E., Marschik, P. B., Coghill, D., et al. (2016). Annual research review: Quality of evidence for psychological therapies in depression. Journal of Child Psychology and Psychiatry, 57(3), 1–10.
Keller, M. B., McCullough, J. P., Klein, D. N., Arnow, B., Dunner, D. L., Gelenberg, A. J., et al. (2000). A comparison of nefazodone, the cognitive behavioral-analysis system of psychotherapy, and their combination for the treatment of chronic depression. New England Journal of Medicine, 342(20), 1462–1470.
Krause, M., Gutsmiedl, K., Bighelli, I., Schneider-Thoma, J., Chaimani, A., & Leucht, S. (2019). Comparative efficacy and tolerability of pharmacological treatments for depression. JAMA Psychiatry, 76(3), 1–10.
Maina, G., Rosso, G., & Bogetto, F. (2009). Relapse prevention in depression: Combined treatment versus pharmacotherapy alone. Journal of Clinical Psychiatry, 70(4), 1–8.
Oliveira, J. R. (2019). Psicoterapia no tratamento da depressão. Revista de Saúde, 45(3), 1–10.
Qaseem, A., Barry, M. J., & Kansagara, D. (2016). Nonpharmacologic versus pharmacologic treatment of adult patients with major depressive disorder. Annals of Internal Medicine, 164(5), 350–359.
Pereira, A. S. et al. (2018). Metodologia da pesquisa científica. [Free ebook]. Editora da UFSM.
Risemberg, R. I. C. et al. (2026). A importância da metodologia científica no desenvolvimento de artigos científicos. E-Acadêmica, 7(1), e0171675.
Rother, E. T. (2007). Revisão sistemática X revisão narrativa. Acta Paulista de Enfermagem, 20(2), v–vi.
Scazufca, M., Menezes, P. R., & Almeida, O. P. (2002). Efficacy of psychotherapies and pharmacotherapy in late-life depression. British Journal of Psychiatry, 181, 1–10.
Schramm, E., Elsaesser, M., Müller, J., et al. (2025). Efficacy of psychotherapy versus pharmacotherapy, or their combination, in chronic depression: Study protocol for a systematic review and network meta-analysis using aggregated and individual patient data. BMJ Open, 15(2), e089356.
Snyder, H. (2019). Literature review as a research methodology: An overview and guidelines. Journal of Business Research, Elsevier. 104(C), 333-9
van Hees, M. L., Rotter, T., Ellermann, T., & Evers, S. M. (2013). The effectiveness of individual interpersonal psychotherapy as a treatment for major depressive disorder. Depression and Anxiety, 30(3), 1–10.
von Wolff, A., Hölzel, L. P., Westphal, A., Härter, M., & Kriston, L. (2012). Combination of pharmacotherapy and psychotherapy in the treatment of chronic depression. Psychological Medicine, 42(1), 1–10.
Zhou, X., Teng, T., Zhang, Y., Del Giovane, C., Furukawa, T. A., Weisz, J. R., et al. (2020). Comparative efficacy and acceptability of antidepressants and psychotherapies in children and adolescents with depression. The Lancet Psychiatry, 7(7), 581–601.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Ingrid Cristine Beringuer de Paulo, Isis Dara Araújo da Silva, Maisa Maura de Oliveira, Milena Fátima de Almeida Botelho, Pedro Wenzel Braga, Raíssa Dias Damasceno, Jonatas Rafael de Oliveira
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
