Combining psychotherapy and pharmacotherapy — structured clinical viva

You are the psychiatry registrar. A 36-year-old woman with recurrent major depression (three lifetime episodes) has remitted on escitalopram 20 mg oral daily but still has residual anhedonia, avoidance of social contact, and fear of relapse. She asks whether combination treatment means she has 'failed' monotherapy, whether she should stop the SSRI now that she feels better, and whether CBT will 'clash' with tablets. Discuss models of combination, landmark evidence, sequential residual-symptom care, relapse prevention, and how you explain integrated care without ideology.