Cognitive reactivity to sad mood provocation and the prediction of depressive relapse.
BACKGROUND
Episode remission in unipolar major depression, while distinguished by minimal symptom burden, can also be a period of marked sensitivity to emotional stress as well as an increased risk of relapse.


OBJECTIVE
To examine whether mood-linked changes in dysfunctional thinking predict relapse in recovered patients who were depressed.


METHODS
In phase 1 of this study, patients with major depressive disorder were randomly assigned to receive either antidepressant medication or cognitive behavior therapy. In phase 2, patients who achieved clinical remission underwent sad mood provocation and were then observed with regular clinical assessments for 18 months.


METHODS
Outpatient psychiatric clinics at the Centre for Addiction and Mental Health, Toronto, Ontario.


METHODS
A total of 301 outpatients with major depressive disorder, aged 18 to 65 years, participated in phase 1 of this study and 99 outpatients with major depressive disorder in remission, aged 18 to 65 years, participated in phase 2.


METHODS
Occurrence of a relapse meeting DSM-IV criteria for a major depressive episode as assessed by the longitudinal interval follow-up evaluation and a Hamilton Depression Rating Scale score of 16 or greater.


RESULTS
Patients who recovered through antidepressant medication showed greater cognitive reactivity following the mood provocation than those who received cognitive behavior therapy. Regardless of type of prior treatment, the magnitude of mood-linked cognitive reactivity was a significant predictor of relapse over the subsequent 18 months. Patients whose mood-linked endorsement of dysfunctional attitudes increased by a minimum of 8 points had a significantly shorter time to relapse than those whose scores were not as elevated.


CONCLUSIONS
The vulnerability of remitted depressed patients for illness relapse may be related to the (re)activation of depressive thinking styles triggered by temporary dysphoric states. This is the first study to link such differences to prognosis following successful treatment for depression. Further understanding of factors predisposing to relapse/recurrence in recovered patients may help to shorten the potentially lifelong course of depression.
Segal
Zindel V
ZV
Department of Psychiatry, University of Toronto, Toronto, Ontario. zindel_segal@camh.net
Kennedy
Sidney
S
Gemar
Michael
M
Hood
Karyn
K
Pedersen
Rebecca
R
Buis
Tom
T
D000161:Acoustic Stimulation / Q000379:methods; D000328:Adult; D000553:Ambulatory Care; D000928:Antidepressive Agents / Q000627:therapeutic use; D001307:Auditory Perception; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology / Q000523:psychology*; D015928:Cognitive Behavioral Therapy; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000523:psychology* / Q000628:therapy; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004644:Emotions; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011939:Mental Recall; D011379:Prognosis; D011569:Psychiatric Status Rating Scales; D012008:Recurrence; D012649:Self Concept; D013315:Stress, Psychological / Q000209:etiology / Q000523:psychology*; D016896:Treatment Outcome
D000928:Antidepressive Agents