Reducing relapse and recurrence in unipolar depression: A comparative meta-analysis of cognitive-behavioral therapy's effects.

Abstract

Relapse and recurrence following response to acute-phase treatment for major depressive disorder (MDD) are prevalent and costly. In a meta-analysis of 28 studies including 1,880 adults, the authors reviewed the world's published literature on cognitive-behavioral therapies (CT) aimed at preventing relapse-recurrence in MDD. Results indicate that after discontinuation of acute-phase treatment, many responders to CT relapse-recur (29% within 1 year and 54% within 2 years). These rates appear comparable to those associated with other depression-specific psychotherapies but lower than those associated with pharmacotherapy. Among acute-phase treatment responders, continuation-phase CT reduced relapse-recurrence compared with assessment only at the end of continuation treatment (21% reduction) and at follow-up (29% reduction). Continuation-phase CT also reduced relapserecurrence compared with other active continuation treatments at the end of continuation treatment (12% reduction) and at follow-up (14% reduction). The authors discuss implications for research and patient care and suggest directions, with methodological refinements, for future studies. Keywordsdepression; relapse and recurrence; cognitive-behavioral therapy; continuation and maintenance treatment; meta-analysis High prevalence and frequent relapse and recurrence amplify the public health significance of major depressive disorder (MDD). Epidemiological estimates place the lifetime prevalence of MDD at more than 16% (Kessler, Berglund, Demler, Jin, & Walters, 2005), and 14% of primary-care patients meet criteria for a major depressive episode (MDE; Ansseau et al., 2004). The large majority of individuals with MDD experience more than one MDE (Judd, 1997;Mueller et al., 1999), and the probability of another MDE increases with each relapserecurrence (Solomon et al., 2000; American Psychiatric Association, 2000a). For example, perhaps 85% of people who recover from an MDE will experience a second MDE within 15 years of naturalistic follow-up, and each additional episode increases the risk of relapserecurrence by 18% (Mueller et al., 1999). Consequently, life interference (e.g., lost work productivity, mortality, lower quality of life) due to MDD rivals that of other chronic diseases such as cancer, diabetes, and heart disease (Murray & Lopez, 1996;Simon, 2003), and most people who commit suicide are depressed (Fawcett, 1993).CorrespondenceThe risk of suicide and life interference can be reduced by shortening the duration of MDEs with effective acute-phase treatments, including pharmacotherapy, interpersonal psychotherapy, and cognitive-behavioral therapy (CT; Hollon, Jarrett, et al., 2005). We define acute-phase treatments as those applied during an MDE with the goal of reducing depressive symptoms and producing initial remission. Responders to some acute-phase treatments (e.g., CT) may receive some protection from relapse-recurrence (Hollon, Thase, & Markowitz, 2002), but prevalent relapse-recurrence after successful antidepressant treatments has ...

The combined cognitive bias hypothesis in depression

“…A State-of-the-art Major depression is a prevalent psychiatric disorder that is associated with debilitating symptomatic suffering, functional impairments, and high societal costs (Kessler & Wang, 2009). Notwithstanding a range of well-established psychological and pharmacological interventions, relapse and recurrence rates of depression remain high (Vittengl, Clark, Dunn, & Jarrett, 2007) indicating that current therapies do not sufficiently address vulnerability factors for this burdensome disorder. Moreover, with each successive depressive episode the risk for recurrence increases (Boland & Keller, 2009), which points to an expanding vulnerability with multiple episodes.…”

Psicoterapia psicodinâmica e tratamento biológico com fluoxetina: comparação de resposta cognitiva em pacientes deprimidos

“…No entanto, o tema é praticamente desconsiderado na literatura da área. Geralmente, associa-se a psicoterapia cognitivo-comportamental a mudanças cognitivas em pacientes (Dobson, 1989;Vittengl, Clark, Dunn, & Jarrett, 2007). Apesar da ampla busca efetuada no PubMed, PsycInfo, MedLine, Scopus e ScienceDirect utilizando-se de descritores que associavam os termos psychodynamic, psychoanalytic, psychoanalysis AND cognition AND cognitive e assemelhados (por exemplo, neuropsychological), foram encontrados alguns poucos artigos relacionando alterações cognitivas com o tratamento psicoterápico psicodinamicamente orientado.…”

The future of psychotherapy research: stop the waste and focus on issues that matter

“…And then there is the problem that more than 40% of the patients do not or only partially respond to treatment and less than one-third of the patients are completely recovered after treatment (Hollon et al 2002). And after successful response the relapse rates are estimated to be 50% after 2 years and up to 80% after 5 years (Vittengl et al 2007). These problems are in addition to the problem that much of the earlier research has considerably overestimated the effects of acute treatments of depression, not only because of publication bias, but also because of the low quality of many trials in the field (Cuijpers et al 2010c) and probably researcher allegiance .…”

“…The Editorials point at the problem that the effects of psychotherapy have been overestimated because of publication bias, but also that the longer term effects of psychotherapies are not well known, except maybe for cognitive-behavioural therapy where longer-term effects have been shown (Karyotaki et al 2014) in several trials. The small effects of psychotherapies and treatments in general in chronic and treatment-resistant depression (Cuijpers et al 2010d) and the high relapse rates after successful recovery (Vittengl et al 2007) are also important problems.…”