Bartova L, Fugger G, Dold M, et al. - Often unsatisfactory outcomes of major depressive disorder (MDD) are encountered despite availability of plenty of effective antidepressant (AD) treatments, this is possibly due to improvable exploitation of available therapies. In this European, cross-sectional, naturalistic multicenter study, the frequency of additional psychotherapy in terms of a manual-driven psychotherapy (MDP) was examined in 1,410 adult in- and outpatients with MDD, who were primarily managed with AD psychopharmacotherapy. Compared with MDD patients receiving exclusively psychopharmacotherapy (68.8%) among 1,279 MDD patients with known status of additional MDP, those undergoing a psychopharmacotherapy-MDP combination (31.2%) were younger, higher educated, more often employed and less severely ill with lower odds of suicidality. In addition, they had an earlier mean age of MDD onset, melancholic features, comorbid asthma and migraine and received lower daily doses of their first-line ADs. While these patients more frequently had agomelatine, MDD patients without MDP more frequently received selective serotonin reuptake inhibitors. Accordingly, there appeared no correlation of the employment of additional MDP with better treatment outcomes in MDD. MDP was herein applied in a minority of patients with rather beneficial socio-demographic and clinical characteristics, which might indicate inferior accessibility of these psychotherapeutic techniques for socially and economically disadvantaged populations.