Enduring effects of Preventive Cognitive Therapy in adults remitted from recurrent depression: A 10 year follow-up of a randomized controlled trial

JOURNAL OF AFFECTIVE DISORDERS

卷:185

Article

Bockting, Claudi L. H.^1,2  Smid, N. Heleen³  Koeter, Maarten W. J.³  Spinhoven, Philip^4,5  Beck, Aaron T.⁶  Schene, Aart H.^7,8 

[1] Univ Utrecht, Dept Clin & Hlth Psychol, NL-3584 CS Utrecht, Netherlands

[2] Univ Groningen, Dept Clin Psychol, Groningen, Netherlands

[3] Univ Amsterdam, Acad Med Ctr, Dept Psychiat, NL-1105 AZ Amsterdam, Netherlands

[4] Leiden Univ, Inst Psychol, Leiden, Netherlands

[5] Leiden Univ, Dept Psychiat, Leiden, Netherlands

[6] Univ Penn, Dept Psychiat, Philadelphia, PA 19104 USA

[7] Radboud Univ Nijmegen, Med Ctr, Dept Psychiat, Nijmegen, Netherlands

[8] Radboud Univ Nijmegen, Med Ctr, Donders Inst Brain Cognit & Behav, Nijmegen, Netherlands

关键词: Cognitive therapy;    Depressive disorder;    Prevention;    Relapse/recattence;    Randomized controlled trial;    Long-term effects;    Maintenance;    Continuation treatment;   

DOI  :  10.1016/j.jad.2015.06.048

来源: Elsevier

【 摘 要 】

Background: Prevention of recurrence is a challenge in the management of major depressive disorder (MDD). The long-term effects of Preventive Cognitive Therapy (PCT) in preventing recurrence in MDD are not known. Methods: A RCT comparing the addition of PCT to Treatment As Usual (TAU), versus TAU including patients with recurrent depression who were in remission at entry (N=172). PCT consisted of eight weekly group sessions. TAU involved standard treatment. Primary outcome is time to first recurrence of a depressive episode as assessed by blinded interviewers over 10 years based on DSM-IV-TR criteria. Results: Also over 10 years, the protective effect of PCT was dependent on the number of previous episodes a patient experienced. The protective effect intensified with the number of previous depressive episodes (Cox regression; p=.004, Hazard ratio=.576, 95% CI=.396-.837) and is mainly established within the first half of the 10 year follow-up period. For patients with more than three previous episodes (52% of the sample), PCT significantly increased the median survival time (713.0 days) versus patients that received TAU (205.0 days). No enduring effects were found on secondary outcomes. Limitations: Dropout rates were relatively high for secondary outcomes, but relatively low for the primary outcome. Results were comparable after multiple imputation. Conclusions: PCT in remitted patients with multiple prior episodes has long-term preventive effects on time to recurrence. To reduce recurrence rates, booster sessions might be necessary. A personalized medicine approach might be necessary to reduce recurrence rates even further. (C) 2015 Elsevier B.V. All rights reserved,

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