symptoms sufficient to meet the criteria for major depression or Hamilton

.

Additional Articles

1: Evid Based Ment Health. 2005 Feb;8(1):12.

Comment on: Arch Gen Psychiatry. 2004 Jul;61(7):714-9.

Review: long term psychotherapy in combination with antidepressants increases compliance and response rates in people with Depression.

Terry CM, Kohlenberg RJ. University of Washington, Seattle WA, USA.

2: Evid Based Ment Health. 2003 Feb;6(1):29.

Comment on: J Affect Disord. 2002 Apr;68(2-3):317-30.

Sertraline with or without interpersonal psychotherapy reduces dysthymia symptoms over psychotherapy alone.

Chisholm D. Health Services Research Department, Institute of Psychiatry, London, United

Kingdom.

3: Arch Gen Psychiatry. 1999 Sep;56(9):829-35.

Prevention of relapse in residual Depression by cognitive therapy: a controlled trial.

Paykel ES, Scott J, Teasdale JD, Johnson AL, Garland A, Moore R, Jenaway A, Cornwall PL, Hayhurst H, Abbott R, Pope M.

Department of Psychiatry, University of Cambridge, Cambridge, England.

BACKGROUND: Previous studies indicate that depressed patients with partial remission and residual symptoms following antidepressant treatment are common and have high rates of relapse. There is evidence that cognitive therapy may reduce relapse rates in Depression. METHODS: One hundred fifty-eight patients with recent major Depression, partially remitted with antidepressant treatment (mean daily doses equivalent to 185 mg of amitriptyline or 33 mg of fluoxetine) but with residual symptoms of 2 to 18 months' duration, were included in a controlled trial. Subjects were randomized to receive clinical management alone or clinical management plus cognitive therapy for 16 sessions during 20 weeks, with 2 subsequent booster sessions. Subjects were assessed regularly throughout the 20 weeks' treatment and for a further year. They received continuation and maintenance antidepressants at the same dose throughout. RESULTS: Cognitive therapy reduced relapse rates for acute major Depression and persistent severe residual symptoms, in both intention to treat and treated per protocol samples. The cumulative relapse rate at 68 weeks was reduced significantly, from 47% in the clinical management control group to 29% with cognitive therapy (hazard ratio 0.54; 95% confidence interval, 0.32-0.93; intention to treat analysis). Cognitive therapy also increased full remission rates at 20 weeks but did not significantly improve symptom ratings. CONCLUSION: In this difficult-to-treat group of patients with residual Depression who showed only partial response

despite antidepressant treatment, cognitive therapy produced worthwhile benefit.

4: Arch Gen Psychiatry. 2005 Apr;62(4):417-22.

Prevention of relapse following cognitive therapy vs medications in moderate to severe Depression.

Hollon SD, DeRubeis RJ, Shelton RC, Amsterdam JD, Salomon RM, O'Reardon JP, Lovett ML, Young PR, Haman KL, Freeman BB, Gallop R. Department of Psychology, Vanderbilt University, 306 Wilson Hall Nashville, TN 37203, USA. steven.d.hollon@vanderbilt.edu

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.