Effects of combined pharmacotherapy and psychotherapy for improving work functioning in major depressive disorder

Br J Psychiatry. 2013 Nov;203(5):358-65. doi: 10.1192/bjp.bp.112.125237. Epub 2013 Sep 12.


Background: Major depressive disorder is associated with significant impairment in occupational functioning and reduced productivity, which represents a large part of the overall burden of depression.

Aims: To examine symptom-based and work functioning outcomes with combined pharmacotherapy and psychotherapy treatment of major depressive disorder.

Method: Employed patients with a DSM-IV diagnosis of major depressive disorder were treated with escitalopram 10-20 mg/day and randomised to: (a) telephone-administered cognitive-behavioural therapy (telephone CBT) (n = 48); or (b) adherence-reminder telephone calls (n = 51). Outcomes included the Montgomery-├ůsberg Depression Rating Scale (MADRS), administered by masked evaluators via telephone, and self-rated work functioning scales completed online. (Registered at clinicaltrials.gov: NCT00702598.)

Results: After 12 weeks, there were no significant between-group differences in change in MADRS score or in response/remission rates. However, participants in the telephone-CBT group had significantly greater improvement on some measures of work functioning than the escitalopram-alone group.

Conclusions: Combined treatment with escitalopram and telephone-administered CBT significantly improved some self-reported work functioning outcomes, but not symptom-based outcomes, compared with escitalopram alone.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Citalopram / administration & dosage
  • Citalopram / therapeutic use*
  • Cognitive Behavioral Therapy / methods*
  • Combined Modality Therapy / methods
  • Depressive Disorder, Major / drug therapy
  • Depressive Disorder, Major / therapy*
  • Employment / psychology
  • Employment / statistics & numerical data*
  • Female
  • Humans
  • Intention to Treat Analysis
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care / statistics & numerical data
  • Psychiatric Status Rating Scales
  • Selective Serotonin Reuptake Inhibitors / administration & dosage
  • Selective Serotonin Reuptake Inhibitors / therapeutic use*
  • Self Report
  • Telemedicine
  • Young Adult


  • Serotonin Uptake Inhibitors
  • Citalopram

Associated data

  • ClinicalTrials.gov/NCT00702598