Background: Psychotherapy added to pharmacotherapy results in greater improvement in clinical outcomes than does pharmacotherapy alone. However, few studies examined how psychotherapy coupled with pharmacotherapy could produce a long-term protective effect by improving the psychobiological stress response. Methods: The researchers recruited 63 subjects with major depressive disorder (MDD) in an outpatient department of psychiatry at a general hospital. The randomly assigned subjects formed 2 groups: 29 in combined therapy (COMB) and 34 in monotherapy (MT). The COMB included 8 weekly body-mind-spirit group psychotherapy sessions added to pharmacotherapy. MT consisted of pharmacotherapy only. The outcome measures, collected at the subjects’ homes, included the Beck Depression Inventory II (BDI-II), the State Trait Anxiety Inventory (STAI) and salivary cortisol on awakening, 45 min after awakening, and at 12.00, 17.00 and 21.00 h. Evaluation of outcome measures was at baseline condition, and at months 2 (end of additional psychotherapy), 5 and 8. Results: While the decreases in symptoms of depression were similar between COMB and MT (p > 0.05), the reductions in anxiety state were greater in COMB than in MT during the 8-month follow-up (p < 0.05). A steeper diurnal cortisol pattern more likely occurred in COMB than in MT in the 3 follow-up periods (p < 0.05, p <0.001 and p < 0.01). Conclusions: The superior outcomes of group psychotherapy added to pharmacotherapy for MDD outpatients could relate to decreasing the anxiety state and to producing long-term impacts on positive stress endocrine outcomes seen as a steeper diurnal cortisol pattern.

1.
Cuijpers P, Dekker P, Hollon SD, Andersson G: Adding psychotherapy to pharmacotherapy in the treatment of depressive disorders in adults: a meta-analysis. J Clin Psychiatry 2009;70:1219–1229.
2.
Petersen TJ: Enhancing the efficacy of antidepressants with psychotherapy. J Psychopharmacol 2006;20:19–28.
3.
Fava GA: The decline of pharmaceutical psychiatry and the increasing role of psychological medicine. Psychother Psychosom 2009;78:220–227.
4.
Imel ZE, Malterer MB, McKay KM, Wampold BE: A meta-analysis of psychotherapy and medication in unipolar depression and dysthymia. J Affect Disord 2008;110:197–206.
5.
Kirschbaum C, Hellhammer DH: Salivary cortisol; in Flink G (ed): Encyclopedia of Stress. San Diego, Academic Press, 2000, pp 329–383.
6.
Bhagwagar Z, Whale R, Cowen PJ: State and trait abnormalities in serotonin function in major depression. Br J Psychiatry 2002;180:24–28.
7.
Sjögren E, Leanderson P, Kristenson M: Diurnal saliva cortisol levels and relations to psychosocial factors in a population sample of middle-aged Swedish men and women. Int J Behav Med 2006;13:193–200.
8.
Yang TT, Hsiao FH, Wang KC, Ng SM, Ho TH, Chan LW, Lai YM, Chen YT: The psychotherapy added to pharmacotherapy on cortisol responses in outpatients with major depressive disorders. J Nerv Ment Dis 2009;197:401–406.
9.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), ed 4. Washington, American Psychiatric Association, 1994.
10.
Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J: An inventory for measuring depression. Arch Gen Psychiatry 1961;4:561–571.
11.
Spielberger CD, Gorsuch RL, Lushene RE: The State-Trait Anxiety Inventory: Test Manual. Palo Alto, Consulting Psychologists Press, 1970.
12.
Ng SM, Chan CLW, Chan LW, Ho DYF, Wong YY, Ho RTH: Stagnation as a distinct clinic syndrome: comparing ‘yu’ (stagnation) in traditional Chinese medicine with depression. Br J Soc Work 2006;36:467–484.
13.
Hsiao FH, Lai YM, Chen YT: Installing hope: the efficacy body-mind-spirit group treatment for Taiwanese female patients with depressive disorders; in Lee MY, Ng SM, Leung PPY, Chan CLW, Leung P (eds): Integrative Body-Mind-Spirit Social Work. Oxford, Oxford University Press, 2009, pp 245–262.
14.
Chan CLW: An Eastern Body-Mind-Spirit Approach: A Training Manual with One-Second Techniques. Hong Kong, Department of Social Work and Social Administration, University of Hong Kong, 2001.
15.
Fava GA, Ruini C: Development and characteristics of a well-being enhancing psychotherapeutic strategy: well-being therapy. J Behav Ther 2003;34:45–63.
16.
Enright RD: Forgiveness Is a Choice: A Step-by-Step Process for Resolving Anger and Restoring Hope. Washington, American Psychological Association, 2001.
17.
Seligman MEP, Csikszentmihalyi M: Positive psychology: an introduction. Am J Psychol 2000;55:5–14.
18.
Gueoriguieva R: Move over ANOVA. Arch Gen Psychiatry 2004;61:310–317.
19.
Littell RC, Pendergast J, Natarajan R: Modelling covariance structure in the analysis of repeated measures data. Stat Med 2000;19:1793–1819.
20.
Kenward MG, Roger JH: Small sample inference for fixed effects from restricted maximum likelihood. Biometrics 1997;53:983–997.
21.
Hollon SD, De Rubeis RJ, Shelton RC, Amsterdam JD, Salomon RM, O’Reardon JR, Lovett ML, Young PR, Haman KL, Freeman BB, Gallop R: Prevention of relapse following cognitive therapy vs medications in moderate to severe depression. Arch Gen Psychiatry 2005;62:417–422.
22.
Burke HM, Davis MC, Otte C, Mohr DC: Depression and cortisol responses to psychological stress: a meta-analysis. Psychoneuroendocrinology 2005;30:846–856.
23.
Carlson L, Speca M, Patel K, Goodey E: Mindfulness-based stress reduction in relation to quality of life, mood, symptom of stress and levels of cortisol, dehydroepiandrosterone sulfate (DHEAS) and melatonin in breast and prostate cancer outpatients. Psychoneuroendocrinology 2004;29:448–474.
24.
Fava GA, Ruini C, Rafanelli C, Grandi S: Cognitive behavior approach to loss of clinical effect during long-term antidepressant treatment. Am J Psychiatry 2002;159:2094–2095.
25.
Friedman MA, Deweiler-Bedell JB, Leventhal H, Horne R, Keitner GI, Miller IW: Combined psychotherapy and pharmacotherapy for the treatment of major depressive disorder. Clin Psychol Sci Prac 2004;11:47–68.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.