Prevention of relapse in residual depression by cognitive therapy - A controlled trial

Background: Previous studies indicate that depressed patients with partial remission and residual symptoms following antidepressant treatment are comm on and have high rates of relapse. There is evidence that cognitive therapy may reduce relapse rates in depression. Methods: One hundred fifty-eight p atients with recent major depression, partially remitted with antidepressan t treatment (mean daily doses equivalent to 185 mg of amitriptyline or 33 m g of fluoxetine) but with residual symptoms of 2 to 18 months' duration, we re included in a controlled trial. Subjects were randomized to receive clin ical 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 ye ar. 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 intentio n to treat and treated per protocol samples. The cumulative relapse rate at 68 weeks was reduced significantly, from 47% in the clinical management co ntrol group to 29% with cognitive therapy (hazard ratio 0.54; 95% confidenc e interval, 0.32-0.93; intention to treat analysis). Cognitive therapy also increased full remission rates at 20 weeks but did not significantly impro ve symptom ratings. Conclusion: In this difficult-to-treat group of patient s with residual depression who showed only partial response despite antidep ressant treatment, cognitive therapy produced worthwhile benefit.