Differences between psychotherapy and pharmacotherapy: combined indications

The treatment of major depressive disorder can be approached from two main angles: psychotherapy and pharmacotherapy. Each has specific foundations, mechanisms of action, and indications. Psychotherapy is based on structured psychological intervention to modify patterns of thought, emotion, and behavior that contribute to the patient's distress.

There are various modalities, such as cognitive-behavioral therapy (CBT), interpersonal psychotherapy (IPT), and psychodynamic therapy. Their application is often particularly useful in mild to moderate depression.

Pharmacotherapy, on the other hand, uses antidepressant medications to regulate the neurotransmitters involved in depression, such as serotonin, norepinephrine, or dopamine. It is mainly indicated in moderate to severe cases, or when there is a risk of suicide, psychotic symptoms, or marked functional impairment.

Criteria for choosing between psychotherapy, pharmacotherapy, or both

The severity of depression is the first clinical criterion that guides the therapeutic decision.

• In mild episodes, it is recommended to start with psychotherapy, self-care measures, and promotion of physical activity.

• In moderate or severe cases, antidepressants are indicated, and they are often combined with psychotherapy as a more effective strategy.

Evidence supports that the combined approach of psychotherapy plus pharmacotherapy has better response rates, lower likelihood of relapse, and greater adherence to treatment, especially in severe or chronic cases.

Psychotherapy: advantages and limitations

Psychotherapy has the great value of providing patients with tools to understand their symptoms, modify negative thought patterns, and develop coping strategies.

It is also a space for working through personal conflicts, losses, or traumas that may underlie the depressive symptoms. However, it may have limitations in cases where there is marked cognitive inhibition, low motivation, intense suicidal ideation, or psychotic symptoms, conditions that may require initial pharmacological stabilization for therapeutic work to be possible.

Pharmacotherapy: advantages and precautions

Antidepressant medication can act more quickly in relieving symptoms and is crucial in severe cases. However, it requires medical monitoring for side effects, such as weight gain, sleep or li