For patients who have recurrent major depressive disorder, getting on the right track back to good health is a matter of critical importance, sometimes even to their livelihood. A recent study found that after undergoing acute phase cognitive therapy, patients do just as well with either continued therapy or by taking the antidepressant drug fluoxetine, commonly known as Prozac, and both treatments help patients avoid relapse.
Researchers from the University of Texas Southwestern Medical Center (UTSMC) and the University of Pennsylvania studied 241 adults who had already undergone the initial phase of cognitive therapy, meaning 12 weeks of 16 to 20 individual sessions. They divided the groups to receive various treatments: 86 received continued cognitive therapy every other week, and eventually monthly. Another 86 patients received Prozac, and the final 69 received a placebo. The participants were assessed after four months and again after eight months by an independent interviewer.
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The patients who received either therapy or Prozac showed similar relapse rates during the first eight months of treatment, with 18.3 percent of those in therapy relapsing, and 18 percent of those on Prozac relapsing. This was significantly better than the individuals who received the placebo, as 32.7 percent of these individuals relapsed, the study, published in JAMA Psychchiatry, stated. The results of the study are in line with other research on how therapy compares to medication in other types of depression, said Deb Serani, PsyD, and author of Living with Depression. Talk therapy and antidepressants both create the same shift in the pre-frontal cortex of the brain. "The takeaway from this is that there's really no wrong approach," Serani said. "It's about what suits your needs."
Matter of Personal Preference
"We're interested in providing efficacious alternatives -- we just want people to get better regardless of how they get there," said study author Robin Jarrett, PhD, psychiatry professor at UTSMC.
It's important that people have options to choose from, because people have different health needs, Jarrett said. For example, a woman who is trying to get pregnant or is breast-feeding may not want to take an anti-depressant. On the other hand, people may not want to set aside time for therapy, or their insurance may only cover so many sessions, so medication might be a better fit for them, Jarrett explained.
Serani said her patients often exhibit a personal preference, and noted that sometimes antidepressants offer a quicker form of relief to depression. Combining the medication with therapy has been found to be particularly effective, because patients start to feel better faster and stay in therapy longer. If a patient doesn't express a preference, Serani said her patients' age often guides her decisions -- for kids and teens, it's often better to start with therapy, though the elderly may prefer the faster relief of antidepressants due to their limited time.
It's critical to note that the therapy used in the study was cognitive behavioral psychotherapy, said Richard Shelton, MD, professor and vice-chair for research at the University of Alabama Department of Psychiatry. The study is "not saying go out and find a therapist," he said, noting that most therapists are not practicing a clinically proven therapy, which is often lost in the debate over therapy.
Importance of Initial Therapy
The researchers followed up with the patients for the next year after they stopped receiving either therapy or the drugs, and found that while the patients receiving intervention did slightly better (35.1 percent had recurrence on Prozac while 35 percent of those getting therapy had recurrence), the relapse rate was not significantly different than those who on the placebo (recurrence rate of 42.7 percent).
The researchers were surprised that these recurrence rates were so similar, Jarrett said. The similar rates may be because all of the adults participating in the trial initially had therapy, which may have given them "some protection," Jarrett said.
The researchers noted that while they expected the patients in therapy to do even better, and hopefully relapse even less frequently than those on the drug, they did note that the patients receiving therapy were more likely to continue with the program than those who received medication. This may be because all the participants knew they would be receiving cognitive therapy in the first part of the study, and so the patients who participated preferred therapy to medication, said Jarrett.
These rates are much lower than relapse rates for people who don't do initial cognitive therapy, so the strongest point the study makes is that this intervention is very essential, said Dr. Shelton. In comparison, the added benefit of continuing either therapy or taking the antidepressant is small in comparison to the large benefit of receiving initial therapy, he said.
The study's results apply to people who are high risk for relapse and recurrence, Jarrett emphasized, noting that it's important that they know they "have a choice even if they're at higher risk."
The research was funded by the National Institute of Mental Health, which employs Jarrett as a consultant. For the first six years of data collection, the Prozac was provided by Eli Lilly.
"Study: Continued Therapy Works as Well as Antidepressants in Preventing Relapse" originally appeared on Everyday Health.