INVITED SYMPOSIUM: When do we need to add pharmacotherapy to psychotherapy for patients with depression, anxiety or personality disorders?
Submission type
Symposium
Scheduled
Parallel Session V: Effectenbeurszaal, 09-06-2018, 09:00 - 10:30
Kernwoorden
pharmacotherapy, psychotherapy depression, anxiety, personality
Onderzoeksgebied
Anxiety and depression
Beknopte samenvatting van de totale bijdrage
This symposium discusses when patients with anxiety disorders needs to combine psychotherapy with pharmacotherapy, whether symptom-specific effects of medication could be identified during psychotherapy for depression, how to prevent relapse with preventive cognitive therapy after stopping antidepressants and how to deal with medication in patients with personality disorders
Auteurs
When do we need psychotherapy to prevent relapse or recurrence and when do we need antidepressants? Results of a three-arm randomised controlled trial
Bockting, C.L. (Claudi), Klein, N.S. (Nicola), Dekker, J (Jack), Hollon, S (Steve)
Abstract ID
1012
Submission type
Oral only
Introductie
Keeping individuals on antidepressants (AD) after remission is a leading strategy to prevent relapse or recurrence. Preventive Cognitive Therapy (PCT) has been proposed as alternative, but it remains unclear whether its addition will either allow AD to be tapered or enhance its efficacy. Methods
Materiaal en methodes
This presentation reports the results of a three-arm RCT, 289 participants with at least two previous depressive episodes who recovered on AD were assigned to PCT+AD, AD, and PCT/-AD. The primary outcome was time-related proportion of depressive relapse/recurrence (intention-to-treat) over 24 months
Resultaten
Eligibility was assessed in 2560 participants of whom 289 were randomised. The overall log-rank test was statistically significant. AD did not reduce the risk of relapse/recurrence more than PCT. Adding PCT to AD resulted in a statistically significant 41% relative risk reduction compared to AD (HR 0.59, CI: 0.38-0.94, p = 0.03).
Conclusie
Maintenance AD treatment is not superior to PCT after recovery. Adding PCT to AD after recovery yielded substantial protective effects over AD. PCT should be offered to recurrently depressed individuals that continue AD and to individuals that wish to stop AD after recovery. The long term potential of psychological interventions compared to-, and added with antidepressants will be discussed.
Auteurs
Pharmacotherapy for patients with personality disorder? What the FAQ!
What psychotherapists and psychiatrists needs to know in split treatment.
Ingenhoven, Th (Theo)
Abstract ID
1013
Submission type
Oral only
Introductie
Psychotherapy, whenever possible, is the first choice of treatment for personality disorders, as advocated in international guidelines. However, with respect to pharmacotherapy these guidelines diverge.
Materiaal en methodes
Presentation of an overview of current evidence-based symptom-specific treatment algorithms for personality disorders, especially borderline personality disorder. We also discuss topics of combining pharmacotherapy and psychotherapy, and how to collaborate within a split-treatment model
Resultaten
As subsequent systematic reviews and meta-analyses on available placebo-controlled pharmacotherapy RCTs differ in their selection of outcome measures, they differ in their conclusions, recommended treatment algorithms and additional proposals.
Conclusie
As we know from clinical practice patients can differ in their response on sedatives, antipsychotics, antidepressants or mood stabilizers. Whereas for some of them these medicines relieve their suffering dramatically without any serious side-effects, for other patients pharmacotherapy makes live unbearable by inducing sedation, numbness, rage or impulsive behaviors. And we discuss other frequent asked questions.
Auteurs
Combining pharmacotherapy with CBT in anxiety disorders and obsessive compulsive disorder
Balkom, A. van (Anton)
Abstract ID
1010
Submission type
Oral only
Introductie
Effective treatments for anxiety disorders and obsessive compulsive disorder mainly consist of cognitive behavioral therapy (CBT) and serotonergic antidepressants (SRI’s). However, certain patients react less favorably to these treatments, and those who do improve frequently suffer from clinically relevant residual symptoms. In order to maximize the effect of treatment with CBT and SRI’s, combining these two treatment modalities has been proposed.
Materiaal en methodes
An overview of several recently published meta-analyses.
Resultaten
The efficacy of combination treatment has been studied in panic disorder with agoraphobia, obsessive compulsive disorder, and social phobia. Generally, the combination of CBT and SRI’s offers little or no advantage over CBT alone. In addition, it may impose an unnecessary burden on health care resources. However, sufficiently powered studies and effectiveness trials in patients seen in clinical practice are needed to examine the real benefits of combining SRI’s and CBT in clinical practice.
Conclusie
Based on the results discussed above, clinicians should not deliver combination treatments by default. Combining CBT and SRI’s should be reserved for non-respondents to these treatments delivered as monotherapy.
Auteurs
Symptom-specific effects of psychotherapy versus combined therapy in the treatment of mild to moderate depression: a network approach
Bekhuis, E (Ella), Schoevers, R.A. (Robert), Boschloo, L (Lynn), Dekker, J (Jack), Van, H.L. (Henricus)
Abstract ID
1011
Submission type
Oral only
Introductie
Adding pharmacotherapy to psychotherapy in the treatment of mild to moderate depression has been reported to have limited effects on scale scores of depressive symptoms. Recently, it has been suggested that individual symptoms on such scales respond differentially to pharmacotherapy, but it is unclear if this pattern also exists when pharmacotherapy is added to psychotherapy. We examine symptom-specific effects of adjunctive pharmacotherapy while considering interrelations among depressive symptoms in a network model
Materiaal en methodes
Data were derived from a randomized controlled trial among outpatients with mild to moderate depression allocated to short psychodynamic supportive psychotherapy (N=103) or this therapy combined with pharmacotherapy (N=83). Depressive symptoms were assessed with the SCL-90 and their interrelations were explored in a partial correlation network.
Resultaten
Seven of the sixteen depressive symptoms responded significantly better to combined therapy than to psychotherapy. After considering symptom interrelatedness, ‘feeling entrapped’ and ‘emotional lability’ showed a strong direct response to the addition of pharmacotherapy, while responses of the remaining symptoms were largely mediated by changes in other symptoms.
Conclusie
Combined therapy outperforms psychotherapy in the treatment of specific depressive symptoms. These findings may help to predict the efficacy of adjunctive pharmacotherapy for individual patients based on their symptom profiles.
Auteurs
