People with a history of depression may sink back into thinking patterns associated with depression when faced with mild stresses or sadness, increasing their risk for relapse.

Many patients who recover from depression eventually relapse, according to background information in the article. Management of depression usually focuses on alleviating symptoms rather than reducing the risk for recurrence or identifying patients who might relapse after successful treatment.

 

Zindel V. Segal, Ph.D., University of Toronto and Centre for Addiction and Mental Health, Ontario, and colleagues randomly assigned 301 patients with major depressive disorder to receive either antidepressant medications or cognitive behavioral therapy (a kind of psychotherapy designed to modify the cognitive processes that are typically associated with depression).

Seventy-eight patients completed the full 18 months of follow-up; 47.5 percent of those who had recovered through antidepressant medication use and 39 percent of those who received cognitive behavioral therapy relapsed during that time period.

Regardless of the type of treatment, those who had greater cognitive reactivity — that is, they displayed significantly more dysfunctional beliefs after the sad mood provocation than before it —w ere more likely to relapse during the 18-month follow-up.

In addition, those who took antidepressants were more likely to have greater cognitive reactivity than those in the cognitive behavioral therapy group.

“Our study indicates that even a mild negative mood, when experienced by someone with a history of depression, can reinstate some of the cognitive features observed in depression itself,” the authors write.

Future depression management approaches might aim to help prevent relapse by teaching patients to reflect on the factors that influence their thinking, the authors suggest.

SOURCE: July issue of Archives of General Psychiatry, one of the JAMA/Archives journals. 

 Other news