Psychotherapy versus the combination of psychotherapy and pharmacotherapy in the treatment of depression: a meta-analysis.
Major depressive disorder (MDD) is a common psychiatric illness. Its 1-year prevalence rates varied in the different regions, for instance 5.1% in Australia, 6.7% in New Zealand, 5.8% in Netherlands, 7.1% in Hungary, 6.2 in Italy, 15-23 % in Republic region of Udmurtia (rural area), 3.5%-10.3% in USA and 4.1%-4.6% in Canada (Handerson et al., 2000; OakleyBrowne et al., 1989; Pakriev et al., 1998; Bijl et al., 1998; Szadoczky et al., 1998; Faravelli et al., 1990; Bourdon et al., 1992; Offord et al., 1996; Bland et al., 1988). However, its prevalence in Taiwan is in a lower range of 0.6%-1.1% (Hwu et al., 1989). According to a meta-analysis of 11 clinical studies, the mean average of its 1-year prevalence rate is 4.1% (95%CI, 2.4% to 6.2%), and its sex-specific 1-year prevalence rates for men and women are 4.9% (95%CI, 3.3% to 7.1%) and 10.0% (95%CI, 6.4% to 14.6%) respectively (Waraich et al., 2004). The lifetime prevalence for MDD patients is 12.6% in New Zealand, 15.4% in Netherlands, 15.1% in Hungary, 13.1% in Italy, 15.7%-22.8% in Switzerland, 9.0% in Germany, 5.9%-17.1% in USA and 8.6%-29.6% in Canada (Oakley-Browne et al., 1989; Bijl et al., 1998; Szadoczky et al., 1998, Carta et al., 1995; Wacker et al.1992; Wittchen et al., 1992 ; Kessler et al., 1994; Bourdon et al., 1992; Murphy et al., 2000; Fournier et al. 1997; Bland et al., 1988). For Asian countries, the prevalence is 1.9% in Hon Kong, 3.4% in Korea and 0.88%-1.7% in Taiwan (Chen et al., 1993; Lee et al., 1987; Hwu et al., 1989). Its prevalence in Puerto Rico is 4.6% (Canino et al., 1987). A meta-analyis of data obtained from several countries revealed that its lifetime prevalence is approximate 3.8% (95%CI, 2.4% to 23.1%) for men and 7.5% (95%CI, 4.5% to 11.3%) for women (Waraich P, 2004). Depression is associated with various chronic medical conditions, including cardiovascular disease, hypertension, diabetes, arthritis and back pain. Recent evidence suggested that it is a primary risk factor for coronary heart disease (CHD), including myocardial infarction (MI) and cardiac death (Lett et al., 2004; Rugulies, 2002). In the contrary, patients with myocardial infarction (MI) and cardiac death also have an increased risk of depression. Depression is also associated with hypertension (Patten, 2001; DiMatteo et al., 2002). Despite of the heterogeneity of results, depression was found to be a risk of poor adherence to antihypertensive medications (Eze-Nliam et al., 2010). Diabetic patients also have a high risk for depression. A systemic review has found that diabetes doubles the odds of comorbid depression (Anderson et al., 2001) and increases the risk for depression for 24% (Nouwen et al., 2010). In the contrary, depression also increases the risk of diabetes development. In addition, depression has been associated with