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J Affect Disord. 2015 Oct 1;185:188-94. doi: 10.1016/j.jad.2015.06.048. Epub 2015 Jul 11.

Enduring effects of Preventive Cognitive Therapy in adults remitted from recurrent depression: A 10 year follow-up of a randomized controlled trial.

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Utrecht University, Department of Clinical and Health Psychology, Utrecht, The Netherlands; University of Groningen, Department of Clinical Psychology, Groningen, The Netherlands. Electronic address:
Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Leiden University, Institute of Psychology and Department of Psychiatry, Leiden, The Netherlands.
Department of Psychiatry, University of Pennsylvania, Philadelphia, USA.
Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Centre, Nijmegen, The Netherlands.



Prevention of recurrence is a challenge in the management of major depressive disorder (MDD). The long-term effects of Preventive Cognitive Therapy (PCT) in preventing recurrence in MDD are not known.


A RCT comparing the addition of PCT to Treatment As Usual (TAU), versus TAU including patients with recurrent depression who were in remission at entry (N=172). PCT consisted of eight weekly group sessions. TAU involved standard treatment. Primary outcome is time to first recurrence of a depressive episode as assessed by blinded interviewers over 10 years based on DSM-IV-TR criteria.


Also over 10 years, the protective effect of PCT was dependent on the number of previous episodes a patient experienced. The protective effect intensified with the number of previous depressive episodes (Cox regression; p=.004, Hazard ratio=.576, 95% CI=.396-.837) and is mainly established within the first half of the 10 year follow-up period. For patients with more than three previous episodes (52% of the sample), PCT significantly increased the median survival time (713.0 days) versus patients that received TAU (205.0 days). No enduring effects were found on secondary outcomes.


Dropout rates were relatively high for secondary outcomes, but relatively low for the primary outcome. Results were comparable after multiple imputation.


PCT in remitted patients with multiple prior episodes has long-term preventive effects on time to recurrence. To reduce recurrence rates, booster sessions might be necessary. A personalized medicine approach might be necessary to reduce recurrence rates even further.


Cognitive therapy; Continuation treatment; Depressive disorder; Long-term effects; Maintenance; Prevention; Randomized controlled trial; Relapse/recurrence

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