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Objective: A paucity of studies use non pharmacological strategies for preventing recurrence in depression. Cognitive behavior treatment of residual symptoms was found to yield a significantly lower relapse rate than clinical management in recurrent depression at a 2-year follow-up. The objective of this investigation was to provide a 6-year follow-up of cognitive behavior treatment versus clinical management. Method: Forty patients with recurrent major depression who had been successfully treated with antidepressant drugs were randomly assigned to either cognitive behavior treatment of residual symptoms (supplemented by lifestyle modification and well-being therapy) or clinical management. In both groups, antidepressant drugs were tapered and discontinued. A 6-year follow-up was undertaken. During this period, no antidepressant drugs were used unless a relapse ensued. Results: Cognitive behavior treatment resulted in a significantly lower relapse rate (40%) at a 6-year follow-up than did clinical management (90%). When multiple recurrences were considered, the group that received cognitive behavior treatment had a significantly lower number of relapses in comparison with the clinical management group. Conclusions: The results suggest that the sequential use of cognitive behavior treatment after pharmacotherapy may improve the long term outcome in recurrent depression. A significant proportion of patients with recurrent depression might be able to withdraw from medication successfully and to stay well for at least 6 years with a focused course of psychotherapy.

Objective: The aims of this investigation were to explore the feasibility of a cognitive behavior approach to loss of clinical effect during long-term antidepressant therapy and to compare it with dose increase. Method: Ten patients with recurrent depression who relapsed while taking antidepressant drugs were randomly assigned to close increase and clinical management or to cognitive behavior therapy and maintenance of the antidepressant drug at the same dose. Results: Four of five patients responded to a larger dose, but all had relapsed again on that dose by the 1-year follow-up. Four of five patients responded to cognitive behavior therapy, and only one relapsed during follow-up. Conclusions: The data suggest that application of a cognitive behavior therapy approach is feasible when there is a loss of clinical effects during long-term antidepressant treatment and may carry long-term benefits. The results need to be confirmed with large-scale controlled studies.