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Preliminary Findings

Giovanni A. Fava, MD; Chiara Rafanelli, MD; Silvana Grandi, MD; Sandra Conti, MD; Piera Belluardo, PhD

Arch Gen Psychiatry. 1998;55:816-820.

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 (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.

From the Department of Psychiatry, State University of New York at Buffalo (Dr Fava), and the Affective Disorders Program and Laboratory of Experimental Psychotherapy, Department of Psychology, University of Bologna, Bologna (Drs Fava, Rafanelli, Grandi, and Conti), and the Department of Statistical Sciences, University of Padova, Padova (Dr Belluardo), Italy.

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