title: Prevention of relapse following cognitive therapy vs medications in moderate to severe depression.
abstract: BACKGROUND
  Antidepressant medication prevents the return of depressive symptoms, but only as long as treatment is continued.
  
  
  OBJECTIVE
  To determine whether cognitive therapy (CT) has an enduring effect and to compare this effect against the effect produced by continued antidepressant medication.
  
  
  METHODS
  Patients who responded to CT in a randomized controlled trial were withdrawn from treatment and compared during a 12-month period with medication responders who had been randomly assigned to either continuation medication or placebo withdrawal. Patients who survived the continuation phase without relapse were withdrawn from all treatment and observed across a subsequent 12-month naturalistic follow-up.
  
  
  METHODS
  Outpatient clinics at the University of Pennsylvania and Vanderbilt University.
  
  
  METHODS
  A total of 104 patients responded to treatment (57.8% of those initially assigned) and were enrolled in the subsequent continuation phase; patients were initially selected to represent those with moderate to severe depression.
  
  
  METHODS
  Patients withdrawn from CT were allowed no more than 3 booster sessions during continuation; patients assigned to continuation medication were kept at full dosage levels.
  
  
  METHODS
  Relapse was defined as a return, for at least 2 weeks, of symptoms sufficient to meet the criteria for major depression or Hamilton Depression Rating Scale scores of 14 or higher during the continuation phase. Recurrence was defined in a comparable fashion during the subsequent naturalistic follow-up.
  
  
  RESULTS
  Patients withdrawn from CT were significantly less likely to relapse during continuation than patients withdrawn from medications (30.8% vs 76.2%; P = .004), and no more likely to relapse than patients who kept taking continuation medication (30.8% vs 47.2%; P = .20). There were also indications that the effect of CT extends to the prevention of recurrence.
  
  
  CONCLUSIONS
  Cognitive therapy has an enduring effect that extends beyond the end of treatment. It seems to be as effective as keeping patients on medication.
authors.affiliation: Department of Psychology, Vanderbilt University, 306 Wilson Hall Nashville, TN 37203, USA. steven.d.hollon@vanderbilt.edu
authors.forename: Steven D
authors.initials: SD
authors.lastname: Hollon
authors.forename: Robert J
authors.initials: RJ
authors.lastname: DeRubeis
authors.forename: Richard C
authors.initials: RC
authors.lastname: Shelton
authors.forename: Jay D
authors.initials: JD
authors.lastname: Amsterdam
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Salomon
authors.forename: John P
authors.initials: JP
authors.lastname: O'Reardon
authors.forename: Margaret L
authors.initials: ML
authors.lastname: Lovett
authors.forename: Paula R
authors.initials: PR
authors.lastname: Young
authors.forename: Kirsten L
authors.initials: KL
authors.lastname: Haman
authors.forename: Brent B
authors.initials: BB
authors.lastname: Freeman
authors.forename: Robert
authors.initials: R
authors.lastname: Gallop
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D000928:Antidepressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D015928:Cognitive Behavioral Therapy; D003866:Depressive Disorder / Q000188:drug therapy / Q000523:psychology / Q000628:therapy*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009749:Nutrition Surveys; D017374:Paroxetine / Q000627:therapeutic use; D010352:Patient Dropouts; D010919:Placebos; D011569:Psychiatric Status Rating Scales; D055502:Secondary Prevention; D012720:Severity of Illness Index
chemical_list: D000928:Antidepressive Agents; D010919:Placebos; D017374:Paroxetine