Counseling can prevent depression recurrence

After being treated with standard medications, patients who undergo a type of counseling called cognitive behavior therapy have a much lower rate of relapse compared with those who receive standard follow-up care, new research shows.

Cognitive behavior therapy or CBT involves learning to recognize distorted thoughts that lead to emotional distress. Instead of attacking the emotion, the patient is taught to address the distorted thought that lead to the emotion. By treating the thought, the emotion often improves.

"A paucity of studies use (non-drug) strategies for preventing recurrence in depression," Dr. Giovanni A. Fava, of the University of Bologna, Italy, and colleagues write in the American Journal of Psychiatry. "Cognitive behavior treatment of residual symptoms was found to yield a significantly lower relapse rate than (usual) management in recurrent depression at a 2-year follow-up."

In their study, the researchers assessed the outcomes of 40 patients with recurrent depression who were successfully treated with drug therapy and then randomly selected to get standard care or cognitive behavior therapy for residual symptoms.

Subjects in both groups had antidepressant drugs tapered and discontinued. The patients were followed for 6 years, during which time no antidepressant drugs were used unless a relapse occurred.

Of the patients who underwent CBT, 40 percent experienced at least one relapse, compared with 90 percent in the usual management group.

Patients in the CBT group had significantly fewer depressive episodes during follow-up than those in the usual management group.

"Cognitive behavior treatment may act on those residual symptoms of major depression that progress to become...symptoms of relapse," the researchers note.

SOURCE: American Journal of Psychiatry, October 2004.