title: Preventing depressive relapse and recurrence in higher-risk cognitive therapy responders: a randomized trial of continuation phase cognitive therapy, fluoxetine, or matched pill placebo.
abstract: OBJECTIVE
  Strategies to improve the course of recurrent major depressive disorder have great public health relevance. To reduce the risk of relapse/recurrence after acute phase cognitive therapy (CT), a continuation phase model of therapy may improve outcomes.
  
  
  OBJECTIVE
  To test the efficacy of continuation phase CT (C-CT) and fluoxetine for relapse prevention in a pill placebo (PBO)-controlled randomized trial and compare the durability of prophylaxis after discontinuation of treatments.
  
  
  METHODS
  A sequential, 3-stage design with an acute phase (all patients received 12 weeks of CT); 8-month experimental phase (responders at higher risk were randomized to C-CT, fluoxetine, or PBO); and 24 months of longitudinal, posttreatment follow-up.
  
  
  METHODS
  Two university-based specialty clinics.
  
  
  METHODS
  A total of 523 adults with recurrent major depressive disorder began acute phase CT, of which 241 higher-risk responders were randomized and 181 subsequently entered the follow-up.
  
  
  METHODS
  Cognitive therapy responders at higher risk for relapse were randomized to receive 8 months of C-CT (n = 86), fluoxetine (n = 86), or PBO (n = 69).
  
  
  METHODS
  Survival analyses of relapse/recurrence rates, as determined by blinded evaluators using DSM-IV criteria and the Longitudinal Interval Follow-up Evaluation. RESULTS As predicted, the C-CT or fluoxetine groups were significantly less likely to relapse than the PBO group across 8 months. Relapse/recurrence rates for C-CT and fluoxetine were nearly identical during the 8 months of treatment, although C-CT patients were more likely to accept randomization, stayed in treatment longer, and attended more sessions than those in the fluoxetine and PBO groups. Contrary to prediction, relapse/recurrence rates following the discontinuation of C-CT and fluoxetine did not differ.
  
  
  CONCLUSIONS
  Relapse risk was reduced by both C-CT and fluoxetine in an enriched randomization sampling only CT responders. The preventive effects of C-CT were not significantly more durable than those of fluoxetine after treatment was stopped, suggesting that some higher-risk patients may require alternate longer-term interventions.
  
  
  BACKGROUND
  clinicaltrials.gov Identifiers: NCT00118404, NCT00183664, and NCT00218764.
authors.affiliation: Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas.
authors.forename: Robin B
authors.initials: RB
authors.lastname: Jarrett
authors.forename: Abu
authors.initials: A
authors.lastname: Minhajuddin
authors.forename: Howard
authors.initials: H
authors.lastname: Gershenfeld
authors.forename: Edward S
authors.initials: ES
authors.lastname: Friedman
authors.forename: Michael E
authors.initials: ME
authors.lastname: Thase
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000517:prevention & control / Q000628:therapy*; D005260:Female; D005473:Fluoxetine / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D010349:Patient Compliance; D010919:Placebos; D055502:Secondary Prevention; D016037:Single-Blind Method
chemical_list: D010919:Placebos; D005473:Fluoxetine