A lifetime approach to major depressive disorder: The contributions of psychological interventions in preventing relapse and recurrence

Abstract

Major depressive disorder (MDD) is highly disabling and typically runs a recurrent course. Knowledge about prevention of relapse and recurrence is crucial to the long-term welfare of people who suffer from this disorder. This article provides an overview of the current evidence for the prevention of relapse and recurrence using psychological interventions. We first describe a conceptual framework to preventive interventions based on: acute treatment; continuation treatment, or; prevention strategies for patients in remission. In brief, cognitive-behavioral interventions, delivered during the acute phase, appear to have an enduring effect that protects patients against relapse and perhaps others from recurrence following treatment termination. Similarly, continuation treatment with either cognitive therapy or perhaps interpersonal psychotherapy appears to reduce risk for relapse and maintenance treatment appears to reduce risk for recurrence. Preventive relapse strategies like preventive cognitive therapy or mindfulness based cognitive therapy (MBCT) applied to patients in remission protects against subsequent relapse and perhaps recurrence. There is some preliminary evidence of specific mediation via changing the content or the process of cognition. Continuation CT and preventive interventions started after remission (CBT, MBCT) seem to have the largest differential effects for individuals that need them the most. Those who have the greatest risk for relapse and recurrence including patients with unstable remission, more previous episodes, potentially childhood trauma, early age of onset. These prescriptive indications, if confirmed in future research, may point the way to personalizing prevention strategies. Doing so, may maximize the efficiency with which they are applied and have the potential to target the mechanisms that appear to underlie these effects. This may help make this prevention strategies more efficacious.

Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder

“…103 The distinction between continuation and maintenance phases was based on a theoretical difference between relapse (symptoms recurring before resolution of the current episode) and recurrence (symptoms that constitute a new episode, after recovery from the previous episode). 103 Recent reviews have highlighted the inconsistent use of these terms and lack of evidence to support distinct demarcations between episodes 104 ; hence, CANMAT continues to endorse a single concept of relapse/recurrence and the 2 treatment phases ( Table 9). …”

“…Table 10 shows the risk factors for recurrence. 104,108 Risk-prediction support tools have been developed to estimate risk of recurrence based on individuals' unique exposure to a key set of risk factors. 109 While risk-prediction Table 11 lists some examples of e-Mental health resources that are evidence-based and/or come from credible sources.…”

Internet-Delivered Disease Management for Recurrent Depression: A Multicenter Randomized Controlled Trial

“…Time-limited continuation and maintenance phase psychotherapies also appear promising for relapse prevention [16,17,18,19,20,21,22,23,24]. Specifically, continuation cognitive therapy and continuation phase fluoxetine were shown to reduce relapse over 8 months significantly more than a pill placebo in adults who responded to acute-phase cognitive therapy and had an elevated risk of relapse due to slow or incomplete remission in acute-phase cognitive therapy.…”

Majör depresyon hastalarında travmatik yaşantılara EMDR uygulamasının tedaviyi güçlendirici etkileri: Olgu serisi

“…Vitriol et al (16), having commonly found traumatic experiences in the history of depressive patients, pointed out the necessity to complement pharmacotherapy with interventions directed at the trauma in order to improve the patients' state. Bockting et al (17) showed that mental trauma is a predisposing factor for repeated and resistant depression. Our contribution also shows the importance of investigating traumatic experiences in depressive patients.…”