The decision to combine both antidepressants with psychotherapy is often individually decided for each patient, and many factors including patient preference, treatment availability, psychosocial factors and cost-effectiveness are often considered by clinicians.

Many times the clinician is faced with consideration of adding psychotherapy to patients who are treated with antidepressants. We reviewed 12 studies in regard to this and found 11 to show superiority of combined treatment in comparison to antidepressant-only treatment of depression (Cuijpers, 2014a; Hollon, 2014; Spijker, 2013; van Hees, 2013; Cuijpers, 2012; Jakobsen, 2012b; Guidi, 2011; Oestergaard, 2011; Cuijpers, 2009b; Cuijpers, 2009c; de Maat, 2008). However, this superiority of combined treatment was limited and unlikely to be of consistent clinical relevance.

Conversely, clinicians are also faced with the consideration of adding antidepressants to patients treated with psychotherapy. We reviewed six studies, which all showed superiority of combined treatment over psychotherapy alone (Cuijpers, 2014; Peeters, 2013; Spijker, 2013; Cuijpers, 2009b; Cuijpers, 2009c; de Maat, 2008). Similarly, this superiority also was of limited clinical significance.

Although many of these studies suggest that combining antidepressants and psychotherapy regularly for the treatment of depression may have limited added benefit, each decision should be made individually for each patient. There may be patients that respond better to combined treatment in comparison to either antidepressants or psychotherapy alone. In addition to this, patients being treated for depression may have other areas in need of treatment that either antidepressants or psychotherapy may not treat alone, such as comorbid mental health disorders or psychosocial stressors or medical issues.