Posted by jrbecker on October 18, 2004, at 9:08:50
CBT after antidepressants improves long-term outcome
Am J Psychiatry 2004; 161: 1872–1876
The sequential use of cognitive behavior therapy (CBT) after drug therapy appears to improve the long-term outcome in patients with recurrent depression, report researchers who found the treatment prevented relapse for at least 6 years in many patients.
For their study, Giovanni Fava and colleagues assigned 40 patients with recurrent major depression who had been successfully treated with antidepressant drugs to receive either CBT or clinical management. In both groups, antidepressant drugs were tapered and discontinued.
The CBT, which involved 30-minute sessions once every other week for 20 weeks, consisted of three main ingredients: cognitive behavior treatment of residual symptoms of major depression, lifestyle modification, and wellbeing therapy.
Over the 6-year follow-up period, CBT was associated with a significantly lower relapse rate, at 40% compared with 60% for patients receiving clinical management.
This difference in relapse rate was significant, both in terms of average survival time and survival analysis, note Fava et al in the American Journal of Psychiatry.
Furthermore, patients treated with CBT had a significantly lower number of recurrences, when multiple relapses were taken into account, than those assigned to clinical management.
The researchers suggest that CBT may act on the residual symptoms of depression that go on to become prodromal symptoms of relapse.
"This may particularly apply to anxiety irritability, which are prominent 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," they write.
Fava and team conclude: "A significant proportion of patients with recurrent depression might be able to withdraw from medication successfully and to stay well for at least 6 years with a focused course of psychotherapy."
They add that even better results may be obtained with longer courses of CBT and, if patients begin to show signs of relapse, additional booster sessions of therapy.
http://www.medwire.md/News_single.aspx?newstype=3&date=20041018&story_id=29205
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