Preventive Cognitive Therapy Enhances Outcomes in Patients on Antidepressants

Information sourced from NEJM Journal Watch:

Patients receiving this therapy can taper their medications and do as well as those who continue them but do best when also maintaining medication.

The best way to combine and sequence antidepressant medication and cognitive-behavioral therapies to optimize long-term outcomes for depressed patients remains unclear. To learn more, researchers conducted a randomized, controlled trial involving 289 depressed subjects who had at least two depressive episodes, who were taking antidepressants (mostly selective serotonin reuptake inhibitors) for at least 6 months, and who were remitted for 2 months up to 2 years.

Participants were randomized to continue medication, receive preventive cognitive therapy (PCT; 8 weekly sessions) plus tapering of antidepressants over 6 months, or receive PCT with continued antidepressants. In a survival analysis examining relapse outcomes through 24 months, PCT plus antidepressant taper and antidepressant taper alone had similar outcomes, but outcomes were better with PCT plus ongoing antidepressants (Kaplan-Meier estimates of recurrence rates, 63%, 60%, and 43%, respectively). The risk reduction for relapse with antidepressants augmented by PCT was 41%.

COMMENT

PCT added to successful antidepressant medication can enhance long-term outcomes and can allow medication taper without resulting in worse outcomes than continued medication alone. These study results contrast with those of mindfulness-based cognitive therapy (MBCT); whereas MBCT added to maintenance antidepressants did not improve outcomes, MBCT prevented worsening outcomes during antidepressant tapering. Because major depression is a very heterogeneous disorder, various forms of cognitive-behavioral therapy will enhance outcomes in many depressed patients already treated with medication and, in some cases, might allow discontinuation of medication without depressive relapse.

Peter Roy-Byrne, MD reviewing Bockting CLH et al. Lancet Psychiatry 2018 May.

CITATION(S):

Bockting CLH et al. Effectiveness of preventive cognitive therapy while tapering antidepressants versus maintenance antidepressant treatment versus their combination in prevention of depressive relapse or recurrence (DRD study): A three-group, multicentre, randomised controlled trial. Lancet Psychiatry 2018 May; 5:401. [PubMed® abstract]

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