New psychotherapeutic approaches to residual symptoms and relapse prevention in unipolar depression

Abstract

Relapse and recurrence are vexing problems of unipolar depression. Awareness of their frequent occurrence has led to the development of pharmacological long-term strategies. A substantial proportion of patients with mood disorders still display residual symptoms upon successful treatment of their illness. Such symptoms were found to entail prognostic value in the prediction of relapse in the entire range of affective disorders. Specific psychotherapeutic strategies for this stage of illness have been developed. One involves cognitive-behavioral treatment of residual symptoms after successful pharmacological therapy of acute depression. This strategy has resulted in a lower relapse rate at a four-year follow-up compared to a clinical management group. The other strategy, based on Ryff's conceptual model, was developed to enhance well-being (well-being therapy). Results from recent pilot studies indicate that well-being therapy may be a promising strategy for decreasing residual symptomatology in affective disorders and thus as a relapse-preventive strategy.

Tertiary intervention for depression and prevention of relapse.

“…On the basis of trials of tricyclic medication, Belsher and Costello (1988) estimated that, following remission or recovery from depression, approximately 50% of patients would experience a relapse within a year after the termination of treatment. This estimate has held up well with newer data, which also indicate that about 50% of patients relapse following the discontinuation of selective serotonin reuptake inhibitors (Paykel et al, 1999;Rafanelli, Park, & Fava, 1999). On the basis of the newer studies, some psychiatrists recommend that the focus of psychopharmacological treatment in depression change from acute-phase treatment to long-term use of medication for maintenance (Donoghue & Hyla, 2001;Keller & Boland, 1998).…”

Severity, course trajectory, and within‐person variability of individual symptoms in patients with major depressive disorder

“…Research on personalized medicine in mental health care and treatment of specific (residual) symptoms has highlighted that a symptom‐specific approach may be beneficial . In general, depression treatment focuses mainly on the core symptoms of depression.…”

Efficacy of the sequential integration of psychotherapy and pharmacotherapy in major depressive disorder: a preliminary meta-analysis

“…Comparable learning may not take place with pharmacotherapy alone (Pava et al 1994; Segal et al 2003; Vittengl et al 2007). In addition, the preventive effects of the sequential strategy seem to be related to an abatement of residual symptoms and/or an increase in psychological well-being and coping skills (Paykel et al 1995; Fava et al 1999; Rafanelli et al 1999; Teasdale et al 2002; Petersen et al 2004).…”