Abstract
BackgroundThe risk of relapse in major depressive disorder (MDD) is associated with high worldwide disease burden. Cognitive behavioral therapy (CBT) and its modifications might be effective in relapse prevention. The aim of this review was to evaluate the efficacy of these treatments for reducing relapse of MDD.MethodsThe retrieval was performed in the databases of MEDLINE via Pubmed, EMBASE and PsycINFO via OVID, The Cochrane Library and four Chinese databases. Clinical trials registry platforms and references of relevant articles were retrieved as well. Hazard ratio (HR) and corresponding 95% confidence interval (CI) were used to pool evidences.ResultsA total of 16 eligible trials involving 1945 participants were included. In the first 12 months, CBT was more efficacious than control in reducing the risk of developing a new episode of depression for MDD patients in remission (HR:0.50, 95%CI:0.35–0.72, I2 = 11%). Mindfulness-based cognitive therapy (MBCT) was more efficacious than control only among patients with 3 or more previous depressive episodes (HR:0.46, 95%CI:0.31–0.70, I2 = 38%). Besides, compared with maintenance antidepressant medication (m-ADM), MBCT was a more effective intervention (HR:0.76, 95%CI:0.58–0.98, I2 = 0%). These positive effects might be only maintained at two and nearly 6 years follow up for CBT.ConclusionThe use of CBT for MDD patients in remission might reduce risk of relapse. Besides, the effect of MBCT was moderated by number of prior episodes and MBCT might only be effective for MDD patients with 3 or more previous episodes. Further exploration for the influence of previous psychological intervention is required.
Highlights
The risk of relapse in major depressive disorder (MDD) is associated with high worldwide disease burden
Analysis found that maintenance Cognitive behavioral therapy (CBT) was only significantly more efficacious than manualized psychoeducation in subjects with five or more previous episodes
The aim of this study was to investigate whether CBT group treatment was effective in reducing residual depression by targeting depressive rumination, authors reported outcome of relapse as secondary outcome
Summary
The risk of relapse in major depressive disorder (MDD) is associated with high worldwide disease burden. Major depressive disorder (MDD) is one of the most common and prevalent mental disorders, which is characterized by low vigor, low mood, low self-confidence, and aversion to activity without a specific reason [1, 2]. It is one of the leading causes of worldwide disability and is associated with approximate 16% lifetime prevalence rate [3, 4]. Sequential pharmacotherapy is associated with high risk of noncompliance [17, 18] and psychotherapy is chosen with intense patient preference [19]. As a result, looking for alternative suitable psychotherapy is a public health priority
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