Neural Implications of Psychotherapy, Pharmacotherapy, and Combined Treatment in Major Depressive Disorder

Abstract

Numerous clinical trials have been conducted to determine the utility of antidepressant treatment (ADT), psychotherapy, and combined psycho-pharmaco-psychotherapy (PPPT) in treating major depressive disorder (MDD). While all approaches have shown benefit over placebo to varying degrees, the parallel neurophysiological mechanisms that underlie their efficacy have received little attention. The authors will review and discuss a growing body of literature that relates the factors of treatment selection and response to the principles of neuromodulation, with emphasis regarding how neuroimaging and other experimental data reinforce the need for personalized MDD treatment. This manuscript and its theoretical approaches were supported by conducting relevant literature searches of MEDLINE and PubMed electronic databases, prioritizing systemic reviews, and randomized clinical trials using selected MeSH terms. The authors conclude that ADT, psychotherapy, and PPPT all create potentially observable neurofunctional changes and argue that additive and synergistic potentiation of these effects in PPPT may produce more sustained symptom relief than with monotherapy alone.

Transcranial direct current stimulation based on quantitative electroencephalogram combining positive psychotherapy for major depression

“…Empowering positive psychology concepts such as optimism and hope can reduce poor functioning and promote behavioral adaptation. Results reported here are in line with Schwartz and Santarsieri [43] who reported that combining antidepressant treatment and psychotherapy (psycho-pharmaco-psychotherapy or PPPT) created potentially ob- servable neurofunctional changes. They suggested that the sum of these effects in PPPT may produce more sustained symptom relief.…”

Bioinformatics Analysis of Potential Biomarkers and Pathway Identification for Major Depressive Disorder

“…If not improved, antidepressant drugs and combined psychotherapy are taken later. As for severe depression, it may need a combination of antidepressants and antipsychotics, antidepressants, and psychotherapy or electroconvulsive therapy [ 16 ]. As for short-term treatment, benzodiazepines are recommended if the patient suffers from acute suicidal depression, catatonic depression, or depression with symptoms, such as insomnia and anxiety [ 17 ].…”