Prevention of recurrent depression with cognitive behavioral therapy - Preliminary findings

被引:330
作者
Fava, GA
Rafanelli, C
Grandi, S
Conti, S
Belluardo, P
机构
[1] Univ Bologna, Dept Psychol, Affect Disorders Program, I-40127 Bologna, Italy
[2] Univ Bologna, Dept Psychol, Lab Expt Psychotherapy, I-40127 Bologna, Italy
[3] Univ Padua, Dept Stat Sci, Padua, Italy
[4] SUNY Buffalo, Dept Psychiat, Buffalo, NY 14260 USA
关键词
D O I
10.1001/archpsyc.55.9.816
中图分类号
R749 [精神病学];
学科分类号
100205 ;
摘要
Background: Cognitive behavioral treatment (CBT) of residual symptoms after successful pharmacotherapy yielded a substantially lower relapse rate than did clinical management in patients with primary major depressive disorders. The aim of this study was to test the effectiveness of this approach in patients with recurrent depression (greater than or equal to 3 episodes of depression). Methods: Forty patients with recurrent major depression who had been successfully treated with antidepressant drugs were randomly assigned to either CBT of residual symptoms (supplemented by lifestyle modification and well-being therapy) or clinical management. In both groups, during the 20-week experiment, antidepressant drug administration was tapered and discontinued. Residual symptoms were measured with a modified version of the Paykel Clinical Interview for Depression. Two-year follow-up was undertaken, during which no antidepressant drugs were used unless a relapse ensued. Results: The CBT group had a significantly lower level of residual symptoms after discontinuation of drug therapy compared with the clinical management group. At 2-year follow-up, CBT also. resulted in a lower relapse rate (25%) than did clinical management (80%). This difference attained statistical significance by survival analysis. Conclusions: These results challenge the assumption that long-term drug treatment is the only tool to prevent relapse in patients with recurrent depression. Although maintenance pharmacotherapy seems to be necessary in some patients, CBT offers a viable alternative for other patients. Amelioration of residual symptoms may reduce the risk of relapse in depressed patients by affecting the progression of residual symptoms to prodromes of relapse.
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页码:816 / 820
页数:5
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