After depression, cognitive therapy is just as effective as antidepressant treatment in preventing recurrence.
Researchers conducted a study to determine the best technique for preventing relapse after depression.
They compared the effectiveness of antidepressant maintenance treatment with cognitive therapy combined with antidepressants, and the same combination but with a decrease in antidepressant treatment.
Their results were published in the Lancet April 3, 2018.
The major depressive episode
According to the researchers, depression is expected to rank second in 2030 in terms of care costs. This is largely due to the highly recurrent nature of this disease. A prevention strategy is therefore essential in patients at high risk of relapse or recurrence.
After depression, a strategy is usually put in place to avoid any risk of relapse or recurrence. The latter is currently based on the use of antidepressants over several months. However, it seems that some people develop some kind of resistance to the properties of antidepressants during a long period of exposure. An alternative could emerge through preventive cognitive therapies.
Evaluate the impact of cognitive therapy
The researchers analyzed in a 24-month randomized controlled trial the number, duration and severity of depression recurrence in people who had already had two or more depressive episodes. All were in remission after antidepressant treatment started for at least 6 months (an SSRI in 80% of cases).
The participants were divided into three groups: the first received antidepressant treatment, the second received preventive cognitive therapy while decreasing antidepressant treatment, the third received preventive cognitive therapy without reducing the dose of antidepressant treatment.
The relevance of cognitive therapy
In practice, the recurrence rate in the antidepressant group associated with cognitive therapy is significantly lower than in the other two groups. Furthermore, no significant difference in the number or severity of recurrences is observed between antidepressants alone and preventive cognitive therapy with reduction of antidepressants.
This randomized clinical trial also shows that, in terms of preventing recurrence, antidepressants are not superior to cognitive therapy with a reduction in antidepressant maintenance treatment. But the combination of this cognitive therapy with antidepressant treatment results in a 41% reduction in risk compared to antidepressants alone.
New research: Effectiveness of preventive cognitive therapy while tapering antidepressants versus maintenance antidepressant treatment versus their combination in prevention of depressive relapse or recurrence (DRD study): a three-group, multicentre RCT https://t.co/DTv92aQcaJ pic.twitter.com/YadfjDTxDH
– The Lancet Psychiatry (@TheLancetPsych) April 4, 2018
This cognitive therapy could in practice be implemented in patients who wish to stop antidepressant treatment after their remission phase, which would avoid the side effects of antidepressant treatments, generally responsible for a lack of compliance.
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