title: Quantifying and qualifying the preventive effects of acute-phase cognitive therapy: Pathways to personalizing care.
abstract: OBJECTIVE
  To determine the extent to which prospectively identified responders to cognitive therapy (CT) for recurrent major depressive disorder (MDD) hypothesized to be lower risk show significantly less relapse or recurrence than treated higher risk counterparts across 32 months.
  
  
  METHODS
  Outpatients (N = 523), aged 18-70, with recurrent MDD received 12-14 weeks of CT. The last 7 consecutive scores from the Hamilton Rating Scale for Depression (HRSD-17) were used to stratify or define responders (n = 290) into lower (7 HRSD-17 scores of less than or equal to 6; n = 49; 17%) and higher risk (n = 241; 83%). The lower risk patients entered the 32-month follow-up. Higher risk patients were randomized to 8 months of continuation-phase CT or clinical management plus double-blind fluoxetine or pill placebo, with a 24-month follow-up.
  
  
  RESULTS
  Lower risk patients were significantly less likely to relapse over the first 8 months compared to higher risk patients (Kaplan-Meier [KM] estimates; i.e., 4.9% = lower risk; 22.1% = higher risk; log-rank χ2 = 6.83, p = .009). This increased risk was attenuated, but not completely neutralized, by active continuation-phase therapy. Over the subsequent 24 months, the lower and higher risk groups did not differ in relapse or recurrence risk.
  
  
  CONCLUSIONS
  Rapid and sustained acute-phase CT remission identifies responders who do not require continuation-phase treatment to prevent relapse (i.e., return of an index episode). To prevent recurrence (i.e., new episodes), however, strategic allocation and more frequent "dosing" of CT and/or targeted maintenance-phase treatments may be required. Longitudinal follow-up is recommended.
authors.affiliation: Department of Psychiatry, The University of Texas Southwestern Medical Center.
authors.forename: Robin B
authors.initials: RB
authors.lastname: Jarrett
authors.affiliation: Department of Clinical Sciences, The University of Texas Southwestern Medical Center.
authors.forename: Abu
authors.initials: A
authors.lastname: Minhajuddin
authors.affiliation: Department of Psychology, Truman State University.
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Vittengl
authors.affiliation: Department of Psychology, Notre Dame University.
authors.forename: Lee Anna
authors.initials: LA
authors.lastname: Clark
authors.affiliation: Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Thase
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use*; D015928:Cognitive Behavioral Therapy; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000517:prevention & control* / Q000523:psychology; D004311:Double-Blind Method; D005260:Female; D005473:Fluoxetine / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D057285:Precision Medicine / Q000379:methods; D012008:Recurrence; D012306:Risk
chemical_list: D018687:Antidepressive Agents, Second-Generation; D005473:Fluoxetine