title: Stable remission and recovery after acute-phase cognitive therapy for recurrent major depressive disorder.
abstract: OBJECTIVE
  Continuation-phase cognitive therapy (C-CT) or fluoxetine (FLX) reduces relapse in adults with major depressive disorder (MDD; Jarrett, Minhajuddin, Gershenfeld, Friedman, & Thase, 2013). Among patients at higher risk for relapse, we hypothesized that continuation-phase treatment reduces residual symptoms and facilitates stable remission and recovery.
  
  
  METHODS
  Outpatients (N = 241) with recurrent MDD who responded to acute-phase CT with higher risk for relapse (i.e., had unstable remission defined by any of the last 7 acute-phase scores ≥ 7 using the Hamilton Rating Scale for Depression; Hamilton, 1960) were randomized to 8 months of C-CT, FLX, or pill placebo and followed for 24 additional months. Psychiatric status ratings (Keller et al., 1987) of 1 or 2 (absent or minimal depressive symptoms) for 6 and 35 continuous weeks post-randomization defined stable remission and recovery, respectively.
  
  
  RESULTS
  Actuarial estimates of stable remission (97%) and recovery (94%) by the end of follow-up were high and did not differ among groups. Observed (unadjusted) proportions of patients remitting (70%) and recovering (47%) before relapse or attrition were lower. During the continuation phase, C-CT (d = 0.21) and FLX (d = 0.25) patients had significantly lower mean depressive symptoms than did controls, but C-CT and FLX patients did not differ from each other, nor did the 3 experimental groups differ during follow-up.
  
  
  CONCLUSIONS
  Many patients who responded to CT with higher relapse risk subsequently remitted and recovered after discontinuation of acute-phase treatment. After discontinuation, C-CT and FLX decreased levels of residual depressive symptoms, but neither significantly increased the likelihood of stable remission or recovery, beyond the moderate to high levels observed among patients who did not relapse.
authors.affiliation: Department of Psychology.
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Vittengl
authors.affiliation: Department of Psychology, University of Notre Dame.
authors.forename: Lee Anna
authors.initials: LA
authors.lastname: Clark
authors.affiliation: Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Thase
authors.affiliation: Department of Psychiatry, The University of Texas Southwestern Medical Center.
authors.forename: Robin B
authors.initials: RB
authors.lastname: Jarrett
mesh_terms: D000208:Acute Disease; D000328:Adult; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use; D015928:Cognitive Behavioral Therapy; D003863:Depression / Q000523:psychology* / Q000628:therapy*; D003865:Major Depressive Disorder / Q000523:psychology* / Q000628:therapy*; D005260:Female; D005473:Fluoxetine / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D011336:Probability; D012008:Recurrence; D016896:Treatment Outcome
chemical_list: D018687:Antidepressive Agents, Second-Generation; D005473:Fluoxetine