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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
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
Posted by Miss Honeychurch on October 18, 2004, at 11:04:55
In reply to CBT after antidepressants helps long-term outcome, posted by jrbecker on October 18, 2004, at 9:08:50
I've been reading a lot on this subject since I'm writing a freelance article about antidepressants vs. psychotherapy.
So I just want to share this statistic (sorry, my sourse is at home, I'll post the source tomorrow, but it is from a respected psychiatric journal).
80% relapse rate back to depression 6 months after meds are stopped.
25% relapse rate back to depression once CBT therapy stopped.
These are in subjects with moderate to severe depression.
Posted by Joslynn on October 20, 2004, at 14:55:04
In reply to relapse rates - CBT vs medication, posted by Miss Honeychurch on October 18, 2004, at 11:04:55
Hi, I have recurrent depression. I've had three severe episdoes, but can go years in between without it. Anyway, I go to a therapist who doesn't do CBT specifically and I also take anti-deps. Do you think that just doing CBT exercises from the various books out there would have the same effect as going to a CBT therapist? I don't want to change therapists at this point to a CBT one, because I like my therapist and she helps in a lot of ways, but she doesn't assign CBT exercises. So can I assign them to myself or does it have to be with a CBT therapist? I guess it couldn't hurt to do it on my own.
Posted by Miss Honeychurch on October 20, 2004, at 15:35:48
In reply to Re: relapse rates - CBT vs medication, posted by Joslynn on October 20, 2004, at 14:55:04
Joslynn,
I'll get you the titles of two books tomorrow. Both have helped me alot with CBT and one has exercises and assignments. I found it enormously helpful.
Posted by Joslynn on October 20, 2004, at 15:48:35
In reply to Re: relapse rates - CBT vs medication, posted by Miss Honeychurch on October 20, 2004, at 15:35:48
Thanks! I already know about the Burns books, but I'm sure there are others.
I figure, the more "arsenal" I get against the depression the better. I do not feel it now, but I know it can come back.
Posted by Miss Honeychurch on October 21, 2004, at 9:09:13
In reply to CBT after antidepressants helps long-term outcome, posted by jrbecker on October 18, 2004, at 9:08:50
Joslynn, these two books have helped m,e a lot with both of my anxiety and depression:
"A New Guide to Rational Living"
and
This last one doesn't mention depression in the title, but I found the last half of the book to be enormously helpful in dealing with/overcoming depression.
Posted by Joslynn on October 21, 2004, at 20:57:46
In reply to For Joslynn, posted by Miss Honeychurch on October 21, 2004, at 9:09:13
Thanks!
The Rational Living book sounded familiar...then I realized that's because it is sitting right here on my bookshelf, being unread! Perhaps I should crack it open again and really pay attention this time.
I will try to get the other one too. Any author with the name Reneau Z Peurifoy has to be interesting!
Posted by Miss Honeychurch on October 22, 2004, at 8:56:57
In reply to Re: For Joslynn, posted by Joslynn on October 21, 2004, at 20:57:46
I know! I have been fascinated with that name for over a year now, ever since my husband bought me that book. BUt I have found it pretty helpful. It is clear and starightforward.
The Guide to Rational Living has been a Godsend for me. I have found it to be a great complement to my therapy and the concepts are all so RATIONAL! CBT centers around the theory that our irrational and skewed thoughts create depression and anxiety. ONce you have accepted a new way, a more rational way, of thinking, depression and anxiety can therefore be unlearned. It has worked wonders for me. I hope you find it helpful!
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