In patients with major depressive disorder (MDD), the frequent occurrence of psychiatric comorbidity and residual symptoms were associated with poor long-term outcome. In response, researches introduced the sequential model, which included a combination of pharmacotherapy and psychotherapy. This study aims to evaluate the impact of sequential combination therapy on the risk of relapse and recurrence of MDD.

This systematic review and meta-analysis included 17 randomized clinical trials examining the effectiveness of the sequential combination therapy for the treatment of adult remitted patients with MDD. The primary outcomes of the study were relapse or recurrence rates of MDD.

Of the 17 studies included in the meta-analysis, one study yielded two comparisons. The study included a total of 2,283 patients, of which 1,208 patients underwent sequential combination therapy, and 1,075 were in the control group. The pooled risk ratio for recurrence/relapse of MDD was 0.84, which indicated that the sequential combination therapy was more likely to prevent the relapse compared with control conditions.

This systematic review and meta-analysis suggested that the sequential combination of psychotherapy followed by pharmacotherapy (either alone or combined with antidepressant medication) resulted in a reduced risk of relapse or recurrence in MDD when compared with the control group.