Preventive cognitive therapy may lead to sustainable treatment results in depression

NEW YORK — In a session here, experts urged adapting more personalized approaches using preventive cognitive therapy to help patients with depression obtain sustainable effects.

Claudi L.H. Bockting, PhD, department of psychiatry, University of Amsterdam, discussed the importance of relapse prevention when treating patients with depression and achieving sustainable response.

Relapse prevention

“One of the major challenges in clinical practice is not only to get initial response, but also to get long-term response, remission and recovery,” Bockting said during her presentation. “Depression is a condition that, for most people, recurred and the risk for relapse is increasing rapidly with the number of previous episodes. After one episode, the chance of relapse is about 50% and about 70% after two or more episodes.”

She presented the results from a recent study published in Lancet Psychiatry. Participants were randomly assigned (10:10:8) to receive preventive cognitive therapy and antidepressants, antidepressants alone or preventive cognitive therapy with tapering of antidepressants over 8 weeks. Two years later, the researchers performed follow-up to determine time to relapse.

In total, 289 participants were randomly assigned to preventive cognitive therapy and antidepressant (n = 104), antidepressant alone (n = 100), or preventive cognitive therapy with tapering of antidepressant (n = 85). The researchers found the overall log-rank test was significant (P = .014). Antidepressants alone were not superior to preventive cognitive therapy, with tapering of antidepressants in terms of the risk for relapse or recurrence (HR = 0.86; 95% CI, 0·56–1·32; P = .502). However, adding preventive cognitive therapy to antidepressant treatment resulted in a 41% relative risk reduction compared with antidepressants alone (P = .026).

“The finding that continuation of antidepressants does not do better than stopping it and getting preventive cognitive therapy might have clinical implications. But now, that leaves us with the question ‘what’ for ‘whom,’” Bockting said during her presentation. “We need to do prospective studies to find this out, but there are some indications – for instance, if there’s unstable resistance, more previous episodes, childhood trauma and very early age of onset – from separate randomized controlled trials that these people do profit more from specific psychological interventions and relapse prevention interventions. Although, this has not been confirmed in the medication tapering trial.”

Preventive cognitive therapy after CBT

In the second presentation, Margo de Jonge, of Arkin Institute for Mental Health, Amsterdam, discussed the preliminary results of a randomized, controlled trial with 15-month follow-up that examined whether offering preventive cognitive therapy would be effective in delaying time to relapse/recurrence in comparison to care as usual in 214 high-risk patients who remitted after CBT.

Participants received preventive cognitive therapy in eight individual, weekly sessions for 45 minutes each to determine time to relapse/recurrence over 15 months.

According to the preliminary findings, preventive cognitive therapy did delay time to relapse recurrence compared with care as usual (primary outcome). However, there were not significant differences between the treatment groups for number of relapse/recurrences or severity of relapse/recurrences.

“Based on this study, we would like to say that after remission on CBT, therapists should consider providing preventive cognitive therapy to patients who are at risk of relapse/recurrence,” de Jonge said during her presentation. “It would be good if preventive cognitive therapy was something therapists would keep in mind if they had patients who were at high risk of relapse/recurrence.” – by Savannah Demko

Reference:

Bockting, CLH.

De Jonge, M. A Personalized Approach to Obtain Sustainable Treatment Results in Depression. Presented at: American Psychiatric Association Annual Meeting; May 5-9, 20178; New York.

Disclosures: The authors report no relevant financial disclosures.