Brief Cognitive Therapy After a Major Depressive Episode Can Have Enduring Benefits

For patients who have recovered from an episode of major depression but are at high risk for recurrence, attending a brief course of group cognitive therapy sessions soon after remission can prevent recurrence for 5 years or more, new research shows.

Treating recently depressed but recovered patients with cognitive therapy is known to help prevent relapse or recurrence, but the long-term effects of this approach are unknown, according to Dr. Claudi L. H. Bockting of University of Groningen, the Netherlands, and colleagues.

In the December issue of the Journal of Clinical Psychiatry, the researchers report on their 5.5-year follow-up study of a randomized controlled trial that had included 172 patients who were enrolled when they were in remission from depression.

"We included a high-risk group for recurrence -- patients who experienced multiple prior episodes," Dr. Bockting noted in an email to Reuters Health.

The patients were randomly assigned to usual care alone or usual care augmented with 8 weekly 2-hour group sessions of cognitive therapy administered by specifically trained psychologists. The preventive cognitive therapy focused mainly on identifying and changing dysfunctional attitudes, enhancing positive memories by keeping a diary of positive experiences, and formulating specific relapse/recurrence prevention strategies, the researchers note.

Overall, 135 patients (79%) experienced relapse/recurrence at least once during follow-up. However, according to Dr. Bockting and colleagues, brief cognitive therapy had a "substantial and enduring" protective effect on relapse/recurrence over the 5.5-year follow-up period.

"We expected that the difference between the groups would fade away after 2 years, but it remained even over almost 6 years," Dr. Bockting said.

The effect was most pronounced in patients with a greater number of previous depressive episodes. In the 52% of study subjects who had experienced four or more depression episodes, cognitive therapy significantly reduced the cumulative relapse/recurrence rate from 95% to 75%.

Despite a clinically significant reduction of relapse or recurrence after brief cognitive therapy, "we should be aware that the actual relapse rates in recurrent depression are still dramatically high," the authors note.

Further research, they add, is needed to identify the "essential ingredients" of the therapies that work, as well as which therapies work the best for specific patient groups, with the goal of bringing relapse rates down further.

In the meantime, based on available evidence, the researchers conclude that "implementing brief relapse prevention cognitive therapy for recurrent depression could be a type of continued care that at least disrupts the rhythm of depression."

J Clin Psychiatry 2009;70:1621-1628.

-From: “Brief Cognitive Therapy After a Major Depressive Episode Can Have Enduring Benefits” by Megan Brooks, Reuters Health Information in Medscape Psychiatry “Adverse Experiences in Childhood and Depression”, January 26, 2010 at http://www.medscape.com/viewarticle/715332 retrieved 1/27/10.

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