Prevention of relapse following cognitive therapy vs medications in moderate to severe depression.
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Patients who responded to CT in a randomized controlled trial were withdrawn from treatment and compared during a 12-month period with medication responders who had been randomly assigned to either continuation medication or placebo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 Patients who survived the continuation phase without relapse were withdrawn from all treatment and observed across a subsequent 12-month naturalistic follow-up.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Patients withdrawn from CT were allowed no more than 3 booster sessions during continuation; patients assigned to continuation medication were kept at full dosage levels.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Patients withdrawn from CT were significantly less likely to relapse during continuation than patients withdrawn from medications (30.8% vs 76.2%; P = .004), and no more likely to relapse than patients who kept taking continuation medication (30.8% vs 47.2%; P = .20).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.
Hollon
Steven D
SD
Department of Psychology, Vanderbilt University, 306 Wilson Hall Nashville, TN 37203, USA. steven.d.hollon@vanderbilt.edu
DeRubeis
Robert J
RJ
Shelton
Richard C
RC
Amsterdam
Jay D
JD
Salomon
Ronald M
RM
O'Reardon
John P
JP
Lovett
Margaret L
ML
Young
Paula R
PR
Haman
Kirsten L
KL
Freeman
Brent B
BB
Gallop
Robert
R
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
D000928:Antidepressive Agents; D010919:Placebos; D017374:Paroxetine