Cognitive behavioral therapy (CBT) is the most effective psychological intervention for the long-term prevention of depression relapse, according to systematic review and meta-analysis findings published in Translational Psychiatry. Notably, mindfulness-based cognitive therapy (MBCT) had a more continuous treatment effect, but for a shorter period.
Investigators conducted a systematic review and meta-analysis to compare the efficacy of psychological interventions in depression over time. The investigators searched publication databases from inception through June 2022 for randomized controlled trials (RCTs) that compared psychological interventions for depression relapse among adults at least 18 years of age, with or without maintenance antidepressant medication (ADM). Inclusion criteria required that participants have a diagnosis of depression and studies have relapse or survival curves for at least 6 months. The investigators excluded studies whose participants samples were only elderly participants, only 1 gender, or patients with bipolar disorder. Furthermore, psychotherapies were compared with placebo or treatment as usual (an intervention that may have treatment effects, but was not considered structured psychotherapy).
These criteria resulted in 25 RCTs with a pooled sample size of 2871. All but 2 studies had a follow-up period of at least 12 months and the study duration range was between 7 and 144 months. The investigators examined 5 types of psychotherapy: CBT, MBCT, behavioral activation therapy, interpersonal psychotherapy, and supportive counseling.
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More evidence is needed from large comparative trials that provide long-term follow-up data.
The investigators found that relative to placebo, MBCT was the only psychotherapy option that was significantly better at preventing depression relapse at the 3-month (odds ratio [OR], 4.33; 95% CI, 1.06-17.76), 6-month (OR, 4.33; 95% CI, 1.06-17.76), and 9-month (OR, 3.71; 95% CI, 1.11-12.39) follow-ups.
The investigators also found that CBT significantly outperformed treatment as usual at the 3-month (OR, 0.44; 95% CI, 0.26-0.76), 9-month (OR, 0.60; 95% CI, 0.40-0.91), 12-month (OR, 0.64; 95% CI, 0.43-0.95), and 15-month (OR, 0.65; 95% CI, 0.44-0.95) follow-ups. Additionally, CBT was significantly better than placebo at the 21-month (OR, 0.14; 95% CI, 0.03-0.58) and 24-month (OR, 0.10; 95% CI, 0.02-0.48) follow-ups.
The investigators then compared psychotherapy to ADM. They found that no psychological intervention outperformed ADM at 3 and 6 months and ADM outperformed CBT at 9 months (OR, 0.11; 95% CI, 0.01-0.84). However, CBT was significantly better at preventing relapse relative to ADM at the 12-month follow-up (OR, 0.12; 95% CI, 0.02-0.73). Yet, ADM once again became more effective than CBT at 15 months (OR, 0.12; 95% CI, 0.02-0.64), 18 months (OR, 0.13; 95% CI, 0.03-0.69), 21 months (OR, 0.08; 95% CI, 0.01-0.48), and 24 months (OR, 0.13; 95% CI, 0.03-0.62).
These findings indicate that while MBCT had the most continuous effect in preventing depression relapse, CBT had the longest impact. However, maintenance ADM still shows the greatest utility at the longest follow-up time points. Review authors concluded, “More evidence is needed from large comparative trials that provide long-term follow-up data.”
These findings may be limited by the low number of studies per intervention type and the analyses did not account for the number of depressive episodes or antidepressant variables (eg, type, dose, duration).
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