Published October 27, 2025
| Version v1
Journal article
Open
Application of combined drug and music therapy in patients with depression
Authors/Creators
- 1. Medical University - Sofia, Sofia, Bulgaria
- 2. Aleksandrovska University General Hospital, Sofia, Bulgaria
Description
Depression is a highly prevalent mood disorder, significantly impairing quality of life and associated with increased mortality. Effective interventions usually involve a combination of pharmacological and psychotherapeutic treatments. As individuals respond differently to various therapeutic approaches, a wide range of possible interventions has been devised. However, the potential of music therapy has not been thoroughly researched.
This study aims to investigate the effect of including music therapy in depression treatment. A total of 62 patients, all receiving antidepressant treatment involving escitalopram, were equally divided into an experimental group and a control group. While the control group remained on medication-only treatment, the experimental group additionally participated in a music therapy program consisting of 10 individual sessions, each lasting 50 minutes. The sessions were structured and included both active and receptive components in a predetermined sequence. The active elements included concentration, coordination, short-term memory, and improvisation exercises, which required motor responses to musical and rhythmic prompts. The receptive components were centered on relaxation exercises.
Progress was tracked at three points – at initiation of treatment, on day 14, and at its conclusion on day 90. Each participant was evaluated by a psychiatrist using the Clinical Global Impression–Severity scale and the Global Assessment of Functioning scale and completed the Zung Self-Rating Depression Scale.
Results indicated a positive therapeutic effect in both groups. However, an additional significant improvement in indicators of anxiety, cognitive factors, and social functioning was observed in the group where drug treatment was combined with music therapy.
Files
PHAR_article_169478.pdf
Files
(472.4 kB)
| Name | Size | Download all |
|---|---|---|
|
md5:fd63ff7178e448927d0109091651b491
|
349.2 kB | Preview Download |
|
md5:87d9b8269cd4f87696de9fef8ac5a43e
|
123.1 kB | Preview Download |
Additional details
References
- Aalbers S, Fusar-Poli L, Freeman RE, Spreen M, Ket JCF, Vink AC, Maratos A, Crawford M, Chen XJ, Gold C (2017) Music therapy for depression. Cochrane Database of Systematic Reviews 11: CD004517. https://doi.org/10.1002/14651858.CD004517.pub3
- Algoodkar S, Sunitha G (2019) Impact of music therapy in reducing the severity of depression measured by MADRS among depression patients: A randomized control study. International Archives of Integrated Medicine 6(1): 41–47. https://iaimjournal.com/wp-content/uploads/2019/01/iaim_2019_0601_07.pdf
- Ballmaier M, Narr KL, Toga AW, Elderkin-Thompson V, Thompson PM, Hamilton L, Haroon E, Pham D, Heinz A, Kumar A (2008) Hippocampal morphology and distinguishing late‐onset from early‐onset elderly depression. American Journal of Psychiatry 165(2): 229–237. https://doi.org/10.1176/appi.ajp.2007.07030506
- Blood AJ, Zatorre RJ (2001) Intensely pleasurable responses to music correlate with activity in brain regions implicated in reward and emotion. Proceedings of the National Academy of Sciences 98(20): 11818–11823. https://doi.org/10.1073/pnas.191355898
- Bradt J, Dileo C, Potvin N (2013a) Music for stress and anxiety reduction in coronary heart disease patients. Cochrane Database of Systematic Reviews 2013(12): CD006577. https://doi.org/10.1002/14651858.CD006577.pub3
- Bradt J, Dileo C, Shim M (2013b) Music interventions for preoperative anxiety. Cochrane Database of Systematic Reviews 6: CD006908. https://doi.org/10.1002/14651858.CD006908.pub2
- Bruscia KE (2014) Defining Music Therapy (3rd Edn.). Barcelona Publishers.
- Chan MF, Wong ZY, Thayala NV (2011) The effectiveness of music listening in reducing depressive symptoms in adults: A systematic review. Complementary Therapies in Medicine 19(6): 332–348. https://doi.org/10.1016/j.ctim.2011.08.003
- Chan MF, Wong ZY, Thayala NV (2012) The effectiveness of music listening in reducing depressive symptoms in adults: A systematic review. Complementary Therapies in Medicine 20(3): 188–196. https://doi.org/10.1016/j.ctim.2011.08.003
- Cipriani A, Furukawa TA, Salanti G, Chaimani A, Atkinson LZ, Ogawa Y, Leucht S, Ruhe HG, Turner EH, Higgins JPT, Egger M, Takeshima N, Hayasaka Y, Imai H, Shinohara K, Tajika A, Ioannidis JPA, Geddes JR (2018) Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: A systematic review and network meta-analysis. The Lancet 391(10128): 1357–1366. https://doi.org/10.1016/S0140-6736(17)32802-7
- Colla M, Kronenberg G, Deuschle M, Meichel K, Hagen T, Bohrer M, Heuser I (2007) Hippocampal volume reduction and HPA-system activity in major depression. Journal of Psychiatric Research 41(7): 553–560. https://doi.org/10.1016/j.jpsychires.2006.06.011
- De Backer J (2008) Music and psychosis: a research report detailing the transition from sensorial play to musical form by psychotic patients. Nordic Journal of Music Therapy 17(2): 89–104. https://doi.org/10.1080/08098130809478202
- Degli Stefani M, Biasutti M (2016) Effects of music therapy on drug therapy of adult psychiatric outpatients: a pilot randomized controlled study. Frontiers in Psychology 7: e1518. https://doi.org/10.3389/fpsyg.2016.01518
- Erkkila J (2024) From signs to symbols, from symbols to words – about the relationship between music and language, music therapy and psychotherapy. Voices. https://voices.no/index.php/voices/article/view/1631/1391
- Erkkilä J, Punkanen M, Fachner J, Ala-Ruona E, Pöntiö I, Tervaniemi M, Vanhala M, Gold C (2011) Individual music therapy for depression: Randomised controlled trial. British Journal of Psychiatry 199(2): 132–139. https://doi.org/10.1192/bjp.bp.110.085431
- Gao Q, Zou K, He Z, Sun X, Chen H (2016) Causal connectivity alterations of cortical-subcortical circuit anchored on reduced hemodynamic response brain regions in first-episode drug-naïve major depressive disorder. Scientific Reports 6(1). https://doi.org/10.1038/srep21861
- Hadley S (2003) Psychodynamic music therapy: An overview. Pschodynamic Music Therapy: Case Studies. Barcelona Publishers, 22 pp.
- Harmer CJ (2008) Serotonin and emotional processing: Does it help explain antidepressant drug action? Neuropharmacology 55(6): 1023–1028. https://doi.org/10.1016/j.neuropharm.2008.06.036
- Heuvel MP, Sporns O (2011) Rich-club organization of the human connectome. Journal of Neuroscience 31(44): 15775–15786. https://doi.org/10.1523/JNEUROSCI.3539-11.2011
- Ivanova E, Panayotova T, Grechenliev I, Peshev B, Kolchakova P, Milanova V (2022) A Complex Combination Therapy for a Complex Disease–Neuroimaging Evidence for the Effect of Music Therapy in Schizophrenia. Frontiers in Psychiatry 13: e795344. https://doi.org/10.3389/fpsyt.2022.795344
- James SL, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, Abbastabar H, Abd-Allah F, Abdela J, Abdelalim A, Abdollahpour I, Abdulkader RS, Abebe Z, Abera SF, Abil OZ, Abraha HN, Abu-Raddad LJ, Abu-Rmeileh NME, Accrombessi MMK, Acharya D (2018) Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: A systematic analysis for the Global Burden of Disease Study 2017. The Lancet 392(10159): 1789–1858. https://doi.org/10.1016/S0140-6736(18)32279-7
- Klapow J, Kroenke K, Horton T, Schmidt S, Spitzer R, Williams JB (2002) Psychological disorders and distress in older primary care patients: A comparison of older and younger samples. Psychosomatic Medicine 64(4): 635–643. https://doi.org/10.1097/01.PSY.0000021942.35402.C3
- Koelsch S (2014) Brain correlates of music-evoked emotions. Nature Reviews Neuroscience 15(3): 170–180. https://doi.org/10.1038/nrn3666
- Kornstein SG, Sloan DME, Thase ME (2002) Gender-specific differences in depression and treatment response. Psychopharmacology Bulletin 36(4): 99–112. https://pubmed.ncbi.nlm.nih.gov/12858149/
- Kornstein SG, Schatzberg AF, Thase ME, Yonkers KA, McCullough JP, Keitner GI, Gelenberg AJ, Ryan CE, Hess AL, Harrison W, Davis SM, Keller MB (2000) Gender differences in chronic major and double depression. Journal of Affective Disorders 60(1): 1–11. https://doi.org/10.1016/S0165-0327(99)00158-5
- Leubner D, Hinterberger T (2017) Reviewing the effectiveness of music interventions in treating depression. Frontiers in Psychology 8: e1109. https://doi.org/10.3389/fpsyg.2017.01109
- Levkovitz Y, Tedeschini E, Papakostas GI (2011) Efficacy of antidepressants for Dysthymia. The Journal of Clinical Psychiatry 72(04): 509–514. https://doi.org/10.4088/JCP.09m05949blu
- Lu Y, Liang H, Han D, Mo Y, Li Z, Cheng Y, Xu X, Shen Z, Tan C, Zhao W, Zhu Y, Sun X (2016) The volumetric and shape changes of the putamen and thalamus in first episode, untreated major depressive disorder. NeuroImage: Clinical 11: 658–666. https://doi.org/10.1016/j.nicl.2016.04.008
- Määttänen I, Martikainen J, Henttonen P, Väliaho J, Thibault M, Palomäki J, Booth RW (2019) Understanding depressive symptoms through psychological traits and physiological stress reactivity. Cogent Psychology 6(1). https://doi.org/10.1080/23311908.2019.1575654
- Magee WL, Siegert RJ, Daveson BA, Lenton-Smith G, Taylor SM (2013) Music Therapy Assessment Tool for Awareness in Disorders of Consciousness (MATADOC): Standardization of the principal subscale to assess awareness in patients with disorders of consciousness. Neuropsychological Rehabilitation 24(1): 101–124. https://doi.org/10.1080/09602011.2013.844174
- Maratos AS, Gold C, Wang X, Crawford MJ (2008) Music therapy for depression. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD004517.pub2
- Murphy JA, Byrne GJ (2012) Prevalence and correlates of the proposed DSM-5 diagnosis of Chronic Depressive Disorder. Journal of Affective Disorders, 139(2): 172–180. https://doi.org/10.1016/j.jad.2012.01.033
- Qin J, Liu H, Wei M, Zhao K, Chen J, Zhu J, Shen X, Yan R, Yao Z, Lu Q (2017) Reconfiguration of hub-level community structure in depressions: A follow-up study via diffusion tensor imaging. Journal of Affective Disorders 207: 305–312. hhttps://doi.org/10.1016/j.jad.2016.09.048
- Romera I, Delgado-Cohen H, Perez T, Caballero L, Gilaberte I (2008) Factor analysis of the Zung self-rating depression scale in a large sample of patients with major depressive disorder in primary care. BMC Psychiatry 8(1). https://doi.org/10.1186/1471-244X-8-4
- Salimpoor VN, Benovoy M, Larcher K, Dagher A, Zatorre RJ (2011) Anatomically distinct dopamine release during anticipation and experience of peak emotion to music. Nature Neuroscience 14(2): 257–262. https://doi.org/10.1038/nn.2726
- Santomauro DF, Herrera AMM, Shadid J, Zheng P, Ashbaugh C, Pigott DM, Abbafati C, Adolph C, Amlag JO, Aravkin AY, Bang-Jensen BL, Bertolacci GJ, Bloom SS, Castellano R, Castro E, Chakrabarti S, Chattopadhyay J, Cogen RM, Collins JK, Dai X (2021) Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic. The Lancet 398(10312): 1700–1712. https://doi.org/10.1016/S0140-6736(21)02143-7
- Särkämö T, Altenmüller E, Rodríguez-Fornells A, Peretz I (2016) Editorial: Music, brain, and rehabilitation: Emerging therapeutic applications and potential neural mechanisms. Frontiers in Human Neuroscience 10. https://doi.org/10.3389/fnhum.2016.00103
- Schotte CKW, Maes M, Cluydts R, Cosyns P (1996) Effects of affective-semantic mode of item presentation in balanced self-report scales: Biased construct validity of the Zung Self-rating Depression Scale. Psychological Medicine 26(6): 1161–1168. https://doi.org/10.1017/S0033291700035881
- Shafer AB (2006) Meta-analysis of the factor structures of four depression questionnaires: Beck, CES-D, Hamilton, and Zung. Journal of Clinical Psychology 62(1): 123–146. https://doi.org/10.1002/jclp.20213
- Silverman MJ (2011) Effects of music therapy on psychiatric patients' proactive coping skills: Two pilot studies. The Arts in Psychotherapy 38(2): 125–129. https://doi.org/10.1016/j.aip.2011.02.004
- Sihvonen AJ, Särkämö T, Leo V, Tervaniemi M, Altenmüller E, Soinila S (2017) Music-based interventions in neurological rehabilitation. The Lancet Neurology 16(8): 648–660. https://doi.org/10.1016/S1474-4422(17)30168-0
- Srivastava S, Bhatia MS, Bhargava SK, Kumari R, Chandra S (2016) A diffusion tensor imaging study using a voxel‐based analysis, region‐of‐interest method to analyze white matter abnormalities in first‐episode, treatment‐naive major depressive disorder. The Journal of Neuropsychiatry and Clinical Neurosciences 28(2): 131–137. https://doi.org/10.1176/appi.neuropsych.15050120
- Stahl SM (2013) Stahl's Essential Psychopharmacology: Neuroscientific Basis and Practical Applications (4th ed.). Cambridge University Press.
- Stern D (2010) The issue of vitality. Nordic Journal of Music Therapy 19(2): 88–102. https://doi.org/10.1080/08098131.2010.497634
- Stewart DE (2003) Physical symptoms of depression: unmet needs in special populations. The Journal of Clinical Psychiatry 64(Suppl 7): 12–16. https://pubmed.ncbi.nlm.nih.gov/12755647/
- Thayer JF, Lane RD (2000) A model of neurovisceral integration in emotion regulation and dysregulation. Journal of Affective Disorders 61(3): 201–216. https://doi.org/10.1016/S0165-0327(00)00338-4
- Thornicroft G, Chatterji S, Evans-Lacko S, Gruber M, Sampson N, Aguilar-Gaxiola S, Al-Hamzawi A, Alonso J, Andrade L, Borges G, Bruffaerts R, Bunting B, de Almeida JMC, Florescu S, de Girolamo G, Gureje O, Haro JM, He Y, Hinkov H, Karam E (2017) Undertreatment of people with major depressive disorder in 21 countries. British Journal of Psychiatry 210(2): 119–124. https://doi.org/10.1192/bjp.bp.116.188078
- Trost W, Ethofer T, Zentner M, Vuilleumier P (2011) Mapping aesthetic musical emotions in the brain. Cerebral Cortex 22(12): 2769–2783. https://doi.org/10.1093/cercor/bhr353
- Vittengl JR, Clark LA, Dunn TW, Jarrett RB (2007) Reducing relapse and recurrence in unipolar depression: A comparative meta-analysis of cognitive-behavioral therapy's effects. Journal of Consulting and Clinical Psychology 75(3): 475–488. https://doi.org/10.1037/0022-006X.75.3.475
- Wang PS, Aguilar-Gaxiola S, Alonso J, Angermeyer MC, Borges G, Bromet EJ, Bruffaerts R, de Girolamo G, de Graaf R, Gureje O, Haro JM, Karam EG, Kessler RC, Kovess V, Lane MC, Lee S, Levinson D, Ono Y, Petukhova M, Posada-Villa J (2007) Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys. The Lancet 370(9590): 841–850. https://doi.org/10.1016/S0140-6736(07)61414-7
- World Health Organization (2025) World Health Organization: Depression. https://www.who.int/news-room/fact-sheets/detail/depression
- Xiao X, Chen W, Zhang X (2023) The effect and mechanisms of music therapy on the autonomic nervous system and brain networks of patients of minimal conscious states: a randomized controlled trial. Frontiers in Neuroscience 17. https://doi.org/10.3389/fnins.2023.1182181
- Yi JH, Brown C, Whitehead G, Piers T, Lee YS, Perez CM, Regan P, Whitcomb DJ, Cho K (2017) Glucocorticoids activate a synapse weakening pathway culminating in tau phosphorylation in the hippocampus. Pharmacological Research 121: 42–51. https://doi.org/10.1016/j.phrs.2017.04.015
- Zhang F, Peng W, Sweeney JA, Jia Z, Gong Q (2018) Brain structure alterations in depression: Psychoradiological evidence. CNS Neuroscience & Therapeutics 24(11): 994–1003. https://doi.org/10.1111/cns.12835