The Netherlands Organisation for Health Research and Development.

Objective:The current study examined whether cognitive reactivity, cognitive extremity reactivity, and mood reactivity following mood provocation predicted relapse in depression over 5.5 years. Additionally, this study was the 1st to examine whether changes in cognitive reactivity and mood reactivity following preventive cognitive therapy (PCT) mediated the preventive effect of PCT on relapse. Method: One hundred eightyseven remitted recurrently depressed outpatients were randomized over treatment as usual (TAU) versus TAU ϩ PCT with 5.5-year follow-up. Relapse in depression was assessed with the Structured Clinical Interview for DSM-IV Axis I Disorders (Spitzer, Williams, Gibbon, & First, 1990). Results: Mood reactivity predicted time to relapse over 5.5 years. We found no evidence that cognitive reactivity was a risk factor for relapse in depression. Moreover, unprimed dysfunctional beliefs predicted relapse directly. There was no indication of mediation by changes in cognitive reactivity (including extremity of the beliefs and unprimed beliefs) or mood reactivity on the preventive effect of PCT. Further, explorative analyses revealed that increases in cognitive and mood reactivity over time also predicted time to relapse. Conclusions: Our findings highlight a need to focus on mood reactivity instead of beliefs as a risk factor for relapse in depression. Similar to a previous study, we found no indications that cognitive therapy after remission reduced dysfunctional beliefs, cognitive reactivity, or extremity. Future studies should examine cognitive reactivity and mood reactivity in daily life as predictors of relapse.

BackgroundTo examine whether a simple Visual Analogue Mood Scale (VAMS) is able to predict time to relapse over 5.5-years.Methodology/Principal Findings187 remitted recurrently depressed out-patients were interviewed using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) and the 17-item Hamilton Depression rating scale (HAM-D) to verify remission status (HAM-D <10). All patients rated their current mood with the help of a Visual Analogue Mood Scale (VAMS) at baseline and at a follow-up assessment three months later. Relapse over 5.5-years was assessed by the SCID-I. Cox regression revealed that both the VAMS at baseline and three months later significantly predicted time to relapse over 5.5-years. Baseline VAMS even predicted time to relapse when the number of previous depressive episodes and HAM-D scores were controlled for. The baseline VAMS explained 6.3% of variance in time to relapse, comparable to the HAM-D interview.Conclusions/SignificanceSad mood after remission appears to play a pivotal role in the course of depression. Since a simple VAMS predicted time to relapse, the VAMS might be an easy and time-effective way to monitor mood and risk of early relapse, and offers possibilities for daily monitoring using e-mail and SMS.Trial RegistrationInternational Standard Randomized Controlled Trial Register Identifier: ISRCTN68246470.

BackgroundMaintenance treatment with antidepressants is the leading strategy to prevent relapse and recurrence in patients with recurrent major depressive disorder (MDD) who have responded to acute treatment with antidepressants (AD). However, in clinical practice most patients (up to 70-80%) are not willing to take this medication after remission or take too low dosages. Moreover, as patients need to take medication for several years, it may not be the most cost-effective strategy. The best established effective and available alternative is brief cognitive therapy (CT). However, it is unclear whether brief CT while tapering antidepressants (AD) is an effective alternative for long term use of AD in recurrent depression. In addition, it is unclear whether the combination of AD to brief CT is beneficial.Methods/designTherefore, we will compare the effectiveness and cost-effectiveness of brief CT while tapering AD to maintenance AD and the combination of CT with maintenance AD. In addition, we examine whether the prophylactic effect of CT was due to CT tackling illness related risk factors for recurrence such as residual symptoms or to its efficacy to modify presumed vulnerability factors of recurrence (e.g. rigid explicit and/or implicit dysfunctional attitudes). This is a multicenter RCT comparing the above treatment scenarios. Remitted patients on AD with at least two previous depressive episodes in the past five years (n = 276) will be recruited. The primary outcome is time related proportion of depression relapse/recurrence during minimal 15 months using DSM-IV-R criteria as assessed by the Structural Clinical Interview for Depression. Secondary outcome: economic evaluation (using a societal perspective) and number, duration and severity of relapses/recurrences.DiscussionThis will be the first trial to investigate whether CT is effective in preventing relapse to depression in recurrent depression while tapering antidepressant treatment compared to antidepressant treatment alone and the combination of both. In addition, we explore explicit and implicit mediators of CT.Trial registrationNetherlands Trial Register (NTR): NTR1907

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