Combining cognitive therapy and medication for mood disorders

Studies of CT in combination with medication, in general, demonstrate a benefit for combination treatment over pharmacotherapy alone in some yet-to-be-identified subgroups of patients with depression. It appears that combination pharmacotherapy plus CT will become the treatment of choice for patients with bipolar illness. Long-range outcomes of patients with major depressive disorder are better when CT is included, regardless of whether CT is concurrent with or follows pharmacotherapy. The research challenge ahead is to determine which patients will most benefit from combined treatment and what is the optimal sequencing of treatments to achieve symptomatic remission, to prevent relapse, to produce recovery, and to avoid recurrence. As in the Keller⁹ study, reports of moderators of therapeutic response are beginning to be identified and point the way to a more sophisticated model of treatment. As the field identifies these moderators of CT and medication response, our preceding speculations should be replaced with and be continuously updated by more refined, evidence based recommendations, guidelines for, and pathways of treatment.