Title of Abstract: How Combination Therapy Effects Hamilton Depression Rating Scale

Scores

Author: Ruth Vasquez, R.N.

Author Affiliation: SUNY Upstate Medical University

Clinical Question/Issue: Does the combination of SSRI’s and psychotherapy improve HAM-D
scores compared to the use of SSRI’s alone in women over the age of 40 with major depression
disorder?

Background/Significance: Depression can be a debilitating disease and has been shown to

affect more women than men. This disease can lead to detrimental health consequences,
including death, if left untreated. Middle-aged women have clinical indicators that can make
them more susceptible to depression given their sex hormones and neurotransmitters that can
solicit brain imbalances.

Intervention or Analysis: A literature review and synthesis of evidence was conducted to

determine the benefits of implementing combination therapy of both pharmacological and
psychotherapy interventions to reduce depressive symptoms as reflected by lower HAM-D
scores. Using the keywords “depression,” “major depression,” “monotherapy,” “combination
therapy,” “SSRI,” “psychotherapy,” and “cognitive behavioral therapy” the databases of
Psychiatric Online, CINAHL, Pubmed, and Upstate Health Sciences Library databases were
searched using inclusion criteria or published dates 2010- 2019 and written in English language.

Discussion: The literature review discusses six research studies that all demonstrate an
improvement in HAM-D scores with combination therapy of SSRI and psychotherapy. The
review appraisal consisted of five articles that are level two category of evidence, given that that
they are research articles of randomized controlled trials and one meta-analysis. The common
theme amongst the studies reflect the preference of psychotherapy as a treatment to either
augment or use as a sole treatment plan for depression that improved HAM-D scores. It was also
noted that patients that do not respond to a single method of treatment significantly benefit from
a combination therapy of both psychotherapy and pharmacotherapy. The pharmacological
method of treatment preferred amongst the elder is SSRI’s due to its decreased interaction to
polypharmacy. Evidence implicated improvement in HAM-D scores and sustained length of
remission for patients who participated in combination therapy.

Keywords: depression, major depression, monotherapy, combination therapy, SSRI,

psychotherapy, cognitive behavioral therapy