Suma P. Chand, PhD Professor Department of Psychiatry and Behavioral Neuroscience Saint Louis University St. Louis, Missouri
Chaitanya Ravi, MD PGY-4 Psychiatry Resident Department of Psychiatry and Behavioral Neuroscience Saint Louis University St. Louis, Missouri
Binu Chakkamparambil, MD PGY-4 Psychiatry Resident Department of Psychiatry and Behavioral Neuroscience Saint Louis University St. Louis, Missouri
Arun Prasad, MD Clinical Extern Zucker Hillside Hospital Long Island Jewish Medical Center Queens, New York
Ankita Vora, MD PGY-4 Clinical Fellow Department of Child and Adolescent Psychiatry Washington University St. Louis, Missouri
Disclosures The authors report no financial relationships with any company whose products are mentioned in this article, or with manufacturers of competing products.
Some evidence suggests that augmenting treatment as usual (TAU) with CBT can have a resilient protective impact that also intensifies with the number of depressive episodes experienced. In an RCT, 172 patients with depression in remission were randomly assigned to TAU or to TAU augmented with CBT.32 The time to recurrence was assessed over the course of 10 years. Augmenting TAU with CBT had a significant protective impact that was greater for patients who had >3 previous episodes.32
Another long-term study assessed the longitudinal course of 158 patients who received CBT, medication, and clinical management, or medication and clinical management alone.33 Patients were followed 6 years after randomization (4.5 years after completion of CBT). Researchers found the effects of CBT in preventing relapse and recurrence persisted for several years.33
Table 224,26,29-32 summarizes the findings of select studies evaluating the use of CBT for the long-term treatment of depression.
Limitations of long-term studies
Studies that have examined the efficacy of adding CBT to antidepressants in the continuation and maintenance treatment of patients with MDD have had some limitations. The definitions of relapse and recurrence have not always been clearly delineated in all studies. This is important because recurrence rates tend to be lower, and long-term follow-up would be needed to detect multiple recurrences so that their incidence is not underestimated. In addition, the types of CBT interventions utilized has varied across studies. Some studies have employed standard interventions such as cognitive restructuring, while others have added strategies that focus on enhancing memories for positive experiences or interventions to encourage medication adherence. Despite these limitations, research has shown promising results and suggests that adding CBT to the maintenance treatment of patients with depression—with or without antidepressants—is likely to reduce the rate of relapse and recurrence.
Consider CBT for all depressed patients
Research indicates that CBT can be the preferred treatment for patients with mild to moderate MDD. Antidepressants significantly reduce depressive symptoms in patients with moderate to severe MDD. Some research suggests that CBT can be as effective as antidepressants for moderate and severe MDD. However, as the severity and chronicity of depression increase, other moderating factors need to be considered. The expertise of the CBT therapist has an impact on outcomes. Treatment protocols that utilize CBT plus antidepressants are likely to be more effective than CBT or antidepressants alone. Incorporating CBT in the acute phase of depression treatment, with or without antidepressants, can have a long-term impact. For maintenance treatment, CBT alone and CBT plus antidepressants have been found to help sustain remission.
