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Cognitive Therapy, Fluoxetine Equally Good Against Depression Recurrence

September 09, 2013
By Will Boggs, MD
NEW YORK (Reuters Health) Sep 09 - In higher-risk patients with depression who respond to cognitive therapy, continuation-phase cognitive therapy and fluoxetine were equally effective at preventing a relapse in a randomized, placebo-controlled trial.
The result was not what the researchers expected.
"The hypothesis that compared to fluoxetine, continuation phase cognitive therapy would reduce relapse/recurrence over the first year after continuation phase treatments were discontinued was not confirmed. Either treatment is an evidence-based choice based on patient preference, availability, and resources," Dr. Robin B. Jarrett from The University of Texas Southwestern Medical Center in Dallas told Reuters Health by email.
In earlier work, Dr. Jarrett and colleagues showed that continuation phase cognitive therapy reduced the risk of relapse/recurrence across eight months of therapy, particularly among patients with early-onset depression and those who had slow or incomplete remissions.
In this study, they randomized patients to continuation phase cognitive therapy or clinical management plus fluoxetine or placebo and compared depressive relapse/recurrence rates across eight months of double-blind therapy and across 24 months of follow-up after discontinuation of therapy.
Of the 241 higher-risk patients described in a report online September 4th in JAMA Psychiatry, 86 were assigned to continuation phase cognitive therapy, 86 to clinical management plus fluoxetine, and 69 to clinical management plus placebo.
Relapse rates over eight months in the fluoxetine and cognitive therapy groups, at 18.0% and 18.3%, respectively, were significantly lower than in the placebo group (32.7%) but not significantly different from each other.
After the full 32 months, relapse/recurrence rates remained similar with fluoxetine and cognitive therapy (41.1% and 45.2%, respectively) but again were lower than with placebo (56.3%).
Patients in the continuation phase cognitive therapy group attended significantly more sessions and stayed in the study significantly longer than patients in the other two arms.
The percentage of patients who completed longitudinal follow-up, though, did not differ according to treatment assignment.
The only negative side effect that was significantly more common with fluoxetine vs placebo was tremors (19.8% vs 5.8%).
"Continuation phase cognitive therapy was associated with less initial drop-out out, more sessions, and longer treatment course than fluoxetine and pill placebo, suggesting that cognitive therapy responders preferred it," Dr. Jarrett said.
The fact that relapse rates were so similar after the continuation phase treatments suggests to Dr. Jarrett that "maintenance phase antidepressant therapies require more evaluation."
As for predicting which patients might respond better to one approach than to the other, Dr. Jarrett said, "This is the topic of another paper which is currently in preparation."
JAMA Psychiatry 2013.

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