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The Effect of Psychotherapy Added to Pharmacotherapy on Cortisol Responses in Outpatients With Major Depressive Disorder

Yang, Tsung-Tsair MD, PhD*; Hsiao, Fei-Hsiu RN, PhD; Wang, Kuo-Chang PhD; Ng, Siu-Man BHSc, PhD§; Ho, Rainbow T. H. PhD§; Chan, Cecilia L. W. PhD§; Lai, Yu-Ming RN, MSN; Chen, Yu-Ting RN, MSN

The Journal of Nervous and Mental Disease: June 2009 - Volume 197 - Issue 6 - p 401-406
doi: 10.1097/NMD.0b013e3181a61594
Original Article

The present study examined the changes of depressive symptoms and salivary cortisol responses in 36 outpatients with major depression. These patients were randomly assigned to receive combination therapy (CT), consisting of antidepressants and body-mind-spirit group psychotherapy, or monotherapy (MT), consisting of antidepressants only. The results indicated that CT and MT had similar effects on reducing depressive symptoms. Nevertheless, the results revealed that cortisol levels at night appeared to have a greater reduction in CT than in MT, indicating a downward trend in CT but an upward trend in MT. Moreover, a steeper diurnal pattern of cortisol—a larger deviation in cortisol levels between 30 and 45 minutes postwaking and evening—was more likely associated with CT than MT. The findings suggest that CT produced a protective effect on outpatients with major depression, preventing the increased night salivary cortisol levels and the flatter diurnal cortisol pattern that tended to occur in MT.

*Department of Psychiatry, Cardinal Tien Hospital and School of Medicine, Fu-Jen University, Taipei, Taiwan; †Department of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan; ‡Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan; §Centre on Behavioral Health, The University of Hong Kong, Hong Kong, People's Republic of China; and ∥School of Nursing, Chang-Gung University, Taipei, Taiwan.

Supported by the National Science Council grant (NSC94-2314-B-038-053).

Send reprint requests to Fei-Hsiu Hsiao, RN, PhD, Department of Nursing, College of Medicine, National Taiwan University, No. 1, Jen-Ai Road, Sec. 1, Taipei 10051, Taiwan. E-mail: or

© 2009 Lippincott Williams & Wilkins, Inc.