Abstract
In a phase 2 trial, Robert DeRubeis and colleagues evaluated antidepressant medication alone or with cognitive behavioural therapy (CBT) to prevent recurrence of depression. In the phase 1 stage of the study, participants with persistent major depressive episode were randomly allocated to antidepressant medication with or without CBT. Participants who achieved recovery were included in the phase 2 study (n=292), CBT ended in the combination cohort, and patients were randomly allocated to medication withdrawal or maintenance. At 3 years follow-up, in the monotherapy phase 1 cohort, risk of depressive recurrence was lower in participants who continued medication in phase 2 compared with medication withdrawal (hazard ratio [HR] 0·47, 95% CI 0·29–0·75; p=0·002). In the combination treatment phase 1 cohort, relapse risk was lower in those who continued medication in phase 2 compared with medication withdrawal (HR 0·46, 95% CI 0·30–0·71; p<0·001).
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