Faculty of Social and Behavioral Sciences, Department of Clinical Psychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands.
J Clin Psychiatry. 2009 Dec;70(12):1621-8. doi: 10.4088/JCP.08m04784blu.
Major depressive disorder (MDD) was projected to rank second on a list of 15 major diseases in terms of burden in 2030. A crucial part of the treatment of depression is the prevention of relapse/recurrence in high-risk groups, ie, recurrently depressed patients. The long-term preventive effects of group cognitive therapy (CT) in preventing relapse/recurrence in recurrent depression are not known. This article reports on the long-term (5.5-year) outcome of a randomized controlled trial to prevent relapse/recurrence in patients with recurrent depression. We specifically evaluated the long-term effects of CT in relation to the number of previous episodes experienced.
From February through September 2000, patients with recurrent depression (DSM-IV-diagnosed) who were in remission (N = 172) were recruited from primary and specialty care facilities. They were randomly assigned to treatment as usual (TAU) versus TAU augmented with brief group CT. The primary outcome measure was time to relapse/recurrence, which was assessed over 5.5 years.
Over 5.5 years, augmenting TAU with CT resulted in a significant protective effect (P = .003), which intensified with the number of previous depressive episodes experienced. For patients with 4 or more previous episodes (52% of the sample), CT significantly reduced cumulative relapse/recurrence from 95% to 75% (medium effect size).
Our findings indicate that brief CT, started after remission from a depressive episode on diverse types of treatment in patients with multiple prior episodes, has long-term preventive effects for at least 5.5 years. Implementation of brief relapse prevention CT should be considered in the continued care of patients with recurrent depression.
ccmo-online.nl Identifier: NTR454.
预计到 2030 年，重度抑郁症（MDD）将在 15 种主要疾病负担清单中排名第二。治疗抑郁症的一个关键部分是预防高危人群（即反复发作的抑郁症患者）的复发/再发。群组认知疗法（CT）在预防复发性抑郁症复发/再发方面的长期预防效果尚不清楚。本文报告了一项预防复发性抑郁症患者复发/再发的随机对照试验的长期（5.5 年）结果。我们特别评估了 CT 在与既往发作次数相关的长期效果。
从 2000 年 2 月到 9 月，从初级保健和专科医疗机构招募了缓解期（DSM-IV 诊断）复发性抑郁症患者（N=172）。他们被随机分配接受常规治疗（TAU）加简短群组 CT 治疗。主要结局指标是复发/再发时间，评估时间为 5.5 年。
在 5.5 年内，用 CT 增强 TAU 治疗显著增强了保护作用（P=.003），这种保护作用随着既往抑郁发作次数的增加而增强。对于有 4 次或更多既往发作的患者（样本的 52%），CT 显著降低了累积复发/再发率，从 95%降至 75%（中等效应大小）。
我们的研究结果表明，在有多次既往发作的患者从抑郁发作的缓解期开始，进行简短的 CT，可以在至少 5.5 年内产生长期预防效果。在复发性抑郁症患者的持续治疗中，应考虑实施简短的复发预防 CT。
ccmo-online.nl 标识符：NTR454。
