Are Depressed Patients Exploited By The Drug Industry?

A study published in the October issue of the American Journal of Psychiatry by an Italian group of investigators headed by Professor Giovanni A. Fava (University of Bologna) suggests, that with appropriate psychosocial interventions, half of the patients with recurrent depression could be still well and drug free six years after termination of treatment, instead of being linked to long term drug treatment.

A number of controlled trials have suggested that cognitive behavior strategies may decrease the risk of relapse in major depressive disorders. The risk of relapse in depression is strongly related to the number of depressive episodes and to the amount of residual symptoms. There is a paucity of studies use nonpharmacological strategies for preventing recurrence in depression. In one of this study, cognitive behavior treatment of residual symptoms was found to yield a significantly lower relapse rate than clinical management in recurrent depression at a 2-year follow-up.

The objective of this investigation was to provide a 6-year follow-up of cognitive behavior treatment versus clinical management. Forty patients with recurrent major depression who had been successfully treated with antidepressant drugs were randomly assigned to either cognitive behavior treatment of residual symptoms (supplemented by lifestyle modification and well-being therapy) or clinical management. In both groups, antidepressant drugs were tapered and discontinued. A 6-year follow-up was undertaken. During this period, no antidepressant drugs were used unless a relapse ensued. Cognitive behavior treatment resulted in a significantly lower relapse rate (40%) at a 6-year follow-up than did clinical management (90%). When multiple recurrences were considered, the group that received cognitive behavior treatment had a significantly lower number of relapses in comparison with the clinical management group. Cognitive behavior treatment was found to be effective in decreasing the residual symptoms of depression. By deferring the psychotherapeutic intervention until after pharmacotherapy, psychotherapy could concentrate only on the symptoms that did not abate after pharmacotherapy. The fact that most of the residual symptoms of depression are also prodromal and that prodromal symptoms of relapse tend to mirror those of the initial episode provides explanation for the protective effect of this targeted treatment. Cognitive behavior treatment may act on those residual symptoms of major depression that progress to become prodromal symptoms of relapse.
The results suggest that the sequential use of cognitive behavior treatment after pharmacotherapy may improve the long-term outcome in recurrent depression. A significant proportion of patients with recurrent depression might be able to withdraw from medication successfully and to stay well for at least 6 years with a focused course of psychotherapy.