Combination treatments including psychotherapy and pharmacotherapy are considered for the majority of mental disorders more effective than monotherapy alone. The effects of psychotherapy added to pharmacotherapy are significantly better than pharmacotherapy alone in patients with depressive and neurotic disorders as reported in several meta-analyses. Psychotherapy in combination with antidepressants significantly improves response rates and for studies longer than 12 weeks, the combined therapy also significantly reduces dropout rates, improves adherence, social functioning and quality of life. Data form controlled trials suggesting that psychological interventions also offer prophylactic effects by providing patients with coping skills to prevent or delay relapse.

However, the inverse question related to the additive effect of pharmacotherapy to long-term psychotherapy is not yet systematically elaborated. In addition, only few studies examined how pharmacotherapy coupled with psychotherapy could produce a long-term neurobiological effect by improving the response to negative and stress events. Studies in depression indicate that additional effects from providing combined psychotherapy and pharmacological treatment could produce a protective effect on stress regulation systems as shown in a diurnal cortisol pattern. Congruently, the neuroimaging analyses have documented that antidepressants and psychotherapy exert similar impact on regional brain activity. Our group compared the changes of regional brain metabolism (18FDG PET) induced by cognitive behavioral therapy (CBT) and antidepressants in patients with panic disorder. Changes in 18FDG uptake after the treatment either with CBT or with antidepressants were similar in number of brain areas, with prominent right-left difference (decrease of metabolism in the right frontal and temporal lobe, and increase in the left hemisphere). These findings support the regionally specific additive neurobiological effect if both therapeutic approaches are combined.

This research was supported by the project 1M0517 MSMT CR and grant NT 11226 IGA MZ CR.