The sequential model in the treatment of depression

Object: Administration of treatments in a sequential order is a common practice in clinical medicine, but has received insufficient attention in psychiatry. The aim of this review was to consider the literature concerned with a sequential use of pharmacotherapy and psychotherapy in depression. Method: A review of the clinical trials where treatment components were used in a sequential order (pharmacotherapy followed by psychotherapy; psychotherapy followed by pharmacotherapy; one drug treatment following another; one psychotherapeutic technique following another) was performed. Results: In unipolar recurrent depression the sequential use of pharmacotherapy was found to improve relapse rate. Conclusions: The sequential treatment of depression does not fall within the realm of maintenance strategies. It is an intensive, two-stage approach, which is based on the fact that one course of treatment with a specific treatment (whether pharmacotherapy or psychotherapy) is unlikely to entail solution to the complex array of symptoms of patients with affective disorders. The sequential model introduces a conceptual shift in current assessment methods.