期刊
JOURNAL OF AFFECTIVE DISORDERS
卷 185, 期 -, 页码 188-194出版社
ELSEVIER SCIENCE BV
DOI: 10.1016/j.jad.2015.06.048
关键词
Cognitive therapy; Depressive disorder; Prevention; Relapse/recattence; Randomized controlled trial; Long-term effects; Maintenance; Continuation treatment
资金
- Netherlands Foundation for Mental Health, Utrecht
- Netherlands organization for health research and development Prevention Program (ZonMw)
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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