Study Examines Long-Term Effects of Continuation Phase Cognitive Therapy on Relapse Rate of Higher-Risk Depressive Patients

For patients with recurrent major depressive disorder that have undergone acute phase cognitive therapy (CT), continuation phase CT (C-CT) does not appear to have greater preventive effects on relapse compared with patients taking fluoxetine (an antidepressant drug) after treatment is stopped, according to a study by Robin B. Jarrett, Ph.D., of The University of Texas Southwestern Medical Center, Dallas, and colleagues.

A total of 523 adults with recurrent major depressive disorder began acute phase CT, of which 241 adults higher-risk responders were randomized to receive eight months of C-CT (n=86), fluoxetine (n=86), or PBO (pill placebo, n=69), and 181 adults subsequently entered the 24 months of longitudinal, posttreatment follow-up.

According to study results, the C-CT or fluoxetine groups were significantly less likely to relapse than the PBO group across eight months. Relapse/recurrence rates for C-CT and fluoxetine were nearly identical during the eight months of treatment, although C-CT patients were more likely to accept randomization, stayed in treatment longer, and attended more sessions than those in the fluoxetine and PBO groups. Contrary to prediction, relapse/recurrence rates following the discontinuation of C-CT and fluoxetine did not differ.

CT responders at higher risk of relapse/recurrence due to slow or incomplete remission can be safely and effectively treated with either continuation phase CT or switching modalities to fluoxetine,” the authors conclude. “After active therapies were discontinued, the preventive effects of both treatments dissipated, suggesting that some higher-risk patients may benefit from additional continuation/maintenance therapies.”

(JAMA Psychiatry. Published online September 4, 2013. doi:10.1001/jamapsychiatry.2013.1969.