Combined Cognitive-Behavioral and Pharmacological Continuation and Maintenance Treatment of Recurrent Depression

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While recurrent depression is an established indicator for pharmacological maintenance treatment, empirical support for the long-term benefit of additional cognitive-behavioral therapy in continuation or maintenance treatment is lacking. The major goal of the study is to compare the long-term outcome of cognitive-behavioural maintenance therapy (CBMT) plus pharmacological continuation/maintenance treatment (treatment as usual, TAU) versus manualized psychoeducation (MAPE) plus TAU for out-patients with recurrent depression in a multi-centre, controlled, randomised trial. Patients meeting the following criteria were included: diagnosis of recurrent depressive disorder (≥ 3 major depressive episodes, MDE), currently in remission; complete remission over 8 weeks after acute treatment of MDE; at least one index depressive episode in the 12 months prior to the intervention. Exclusion criteria were: organic disorder; psychological / behavioural disorders caused by psychotropic substances; schizophrenia; schizoaffective disorder; bipolar depression; moderate to severe mental retardation; acute suicidality; severe comorbid medical condition. Patients meeting the inclusion criteria were randomly assigned to one of the two conditions (CBMT plus TAU or MAPE plus TAU). Currently, 186 patients have been recruited from 12 outpatient clinics of psychiatric hospitals and psychological departments in the Rhine-Main region and Thuringia. Funding of the trial presently covers an assessment of the effects of both treatment forms on the occurrence of relapse/recurrence of MDE for a period of only one year following treatment. There are no such long-term follow-ups of large and well controlled trails available. But in recurrent depression long-term relapse prevention is the most relevant outcome criteria.