Cognitive Behavior Therapy Can Prevent Recurrent Depression

NEW YORK (Reuters Health) Nov 08 - Patients who undergo cognitive behavior therapy after successful pharmacotherapy have a substantially lower rate of relapse compared with those who are followed with clinical management only, according to researchers.

"A paucity of studies use nonpharmacological strategies for preventing recurrence in depression," Dr. Giovanni A. Fava, of the University of Bologna, Italy, and colleagues write in the October issue of the American Journal of Psychiatry. "Cognitive behavior treatment of residual symptoms was found to yield a significantly lower relapse rate than clinical management in recurrent depression at a 2-year follow-up."

In the current study, the researchers randomized 40 patients with recurrent major depression who were successfully treated with antidepressant therapy to cognitive behavior treatment of residual symptoms or clinical management. Cognitive behavior treatment was supplemented by lifestyle modification and well-being therapy.

Subjects in both groups had antidepressant drugs tapered and discontinued. The patients were followed for 6 years. No antidepressant drugs were used during follow-up unless a relapse occurred.

Of the patients who underwent cognitive behavior treatment, eight (40%) experienced at least one relapse, compared with 18 (90%) in the clinical management group (p = 0.001).

Four of the eight patients in the cognitive behavior treatment group and 11 of the 18 patients in the clinical management group who had a first relapse and were administered clonazepam experienced a second relapse.

Patients in the cognitive behavior treatment group had significantly fewer depressive episodes during follow-up than those in the clinical management group (12 versus 34, respectively; p < 0.001).

"Cognitive behavior treatment may act on those residual symptoms of major depression that progress to become prodromal symptoms of relapse," the researchers note. "This may particularly apply to anxiety and irritability, which are predominant in the prodromal phase of depression, may be covered by mood disturbances but are still present in the acute phase, and are again a prominent feature of its residual phase."

Am J Psychiatry 2004;161:1872-1876.

Admin note: The drug "clonazepam" mentioned above is a mild tranquilizer, not an antidepressant.