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Original Article
April 2005

Prevention of Relapse Following Cognitive Therapy vs Medications in Moderate to Severe Depression

Author Affiliations

Author Affiliations: Departments of Psychology (Dr Hollon) and Psychiatry (Drs Shelton, Salomon, and Haman and Ms Lovett), Vanderbilt University, Nashville, Tenn; Departments of Psychology (Dr DeRubeis) and Psychiatry (Drs Amsterdam, O’Reardon, and Young and Mr Freeman), University of Pennsylvania, Philadelphia; and Department of Mathematics and Applied Statistics, West Chester University, West Chester, Pa (Dr Gallop).

Arch Gen Psychiatry. 2005;62(4):417-422. doi:10.1001/archpsyc.62.4.417
Abstract

Background  Antidepressant medication prevents the return of depressive symptoms, but only as long as treatment is continued.

Objectives  To determine whether cognitive therapy (CT) has an enduring effect and to compare this effect against the effect produced by continued antidepressant medication.

Design  Patients who responded to CT in a randomized controlled trial were withdrawn from treatment and compared during a 12-month period with medication responders who had been randomly assigned to either continuation medication or placebo withdrawal. Patients who survived the continuation phase without relapse were withdrawn from all treatment and observed across a subsequent 12-month naturalistic follow-up.

Setting  Outpatient clinics at the University of Pennsylvania and Vanderbilt University.

Patients  A total of 104 patients responded to treatment (57.8% of those initially assigned) and were enrolled in the subsequent continuation phase; patients were initially selected to represent those with moderate to severe depression.

Interventions  Patients withdrawn from CT were allowed no more than 3 booster sessions during continuation; patients assigned to continuation medication were kept at full dosage levels.

Main Outcome Measures  Relapse was defined as a return, for at least 2 weeks, of symptoms sufficient to meet the criteria for major depression or Hamilton Depression Rating Scale scores of 14 or higher during the continuation phase. Recurrence was defined in a comparable fashion during the subsequent naturalistic follow-up.

Results  Patients withdrawn from CT were significantly less likely to relapse during continuation than patients withdrawn from medications (30.8% vs 76.2%; P = .004), and no more likely to relapse than patients who kept taking continuation medication (30.8% vs 47.2%; P = .20). There were also indications that the effect of CT extends to the prevention of recurrence.

Conclusions  Cognitive therapy has an enduring effect that extends beyond the end of treatment. It seems to be as effective as keeping patients on medication.

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