Psychotherapy and Pharmacotherapy for Major Depressive Disorder and Generalized Anxiety Disorder: A Rapid Qualitative Review


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Project Line:
Health Technology Review
Project Sub Line:
Summary with Critical Appraisal
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  1. How have people living with major depressive disorder and/or generalized anxiety disorder experienced pharmacotherapy and psychotherapy? What are their perspectives on the various treatment approaches?
  2. How have families, caregivers, and health care providers who care for people with MDD and/or GAD experienced pharmacotherapy and psychotherapy? What are their perspectives on the various treatment approaches?

Key Message

This rapid review summarizes the results of 29 studies that relate to the experiences and perspectives of patients, providers, and caregivers in relation to different forms of treatment for major depressive disorder and/or generalized anxiety disorder, with a focus on a stepped care approach.

Across included studies, participants described a range of perceived benefits across a range of interventions. At the same time, experiences were varied across studies. Some interventions—or aspects of interventions—were perceived as more suitable and acceptable to some individuals, suggesting a need for the tailoring of mental health interventions to ensure individualized and patient-centered care. Tailoring would appear to help ensure that the right intervention is offered for the right individual in their particular circumstance. Aspects of tailoring may include consideration of patient-level characteristics—for example, age, disease severity and personal preferences; intervention-level characteristics—for example low versus high intensity interventions, therapist involvement and support; and organizational-level characteristics—for example clinical setting and consideration of competing life and work demands.

The need for therapist support emerged through conversations relating to both low and high intensity interventions, and was echoed by patients, parents and health care providers. While not universal, concerns were expressed when people did not feel consistently supported by a health care practitioner, often expressing a lack of confidence to engage in treatment independent of therapist support and unable or unwilling to take on the responsibility for their own treatment. For high intensity interventions in particular, the importance of a therapeutic relationship emerged as an important factor influencing people’s experiences. 

The role of parent as therapist emerged in studies describing parents’ experiences supporting their child through care. Despite a desire to be included in the treatment process, parents also consistently expressed difficulties working alongside their child in this role. Parents described issues related to identity and role clarity, as they observed their role shifting from one of “parent” to one of “therapist”. Some described feeling unqualified, without adequate resources, and inadequately trained to assist in implementation of treatment at home. 

Hesitations to engage in treatment were described, in particular for high-intensity interventions. For psychotherapy, participants described being most influenced by how their therapist perceived them, how they treated them, and what they expected or asked of them. A safe, friendly environment where people can safely discuss their feelings may enhance the therapeutic relationship, and positive engagement with treatment. A range of hesitations to engage in pharmacological therapy were likewise reported, including fears around addiction, a perceived inability to discontinue treatment due to the potential for relapse, and being perceived as “weak”.