دورية أكاديمية
Effectiveness of preventive cognitive therapy while tapering antidepressants versus maintenance antidepressant treatment versus their combination in prevention of depressive relapse or recurrence (DRD study): a three-group, multicentre, randomised controlled trial.
| العنوان: | Effectiveness of preventive cognitive therapy while tapering antidepressants versus maintenance antidepressant treatment versus their combination in prevention of depressive relapse or recurrence (DRD study): a three-group, multicentre, randomised controlled trial. |
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| المؤلفون: | Bockting CLH; Academic Medical Centre, Department of Psychiatry, University of Amsterdam, Amsterdam, Netherlands; Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, Netherlands. Electronic address: c.l.bockting@amc.uva.nl., Klein NS; Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, Netherlands., Elgersma HJ; Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, Netherlands., van Rijsbergen GD; Department of Early Detection and Intervention in Psychosis, GGZ Drenthe, Assen, Netherlands., Slofstra C; Lentis Psychiatric Institute, Lentis Research, Groningen, Netherlands., Ormel J; University Medical Centre Groningen, Department of Psychiatry, University of Groningen, Groningen, Netherlands., Buskens E; Health Technology Assessment, University of Groningen, Groningen, Netherlands., Dekker J; Department of Clinical, Neuro and Developmental Psychology, VU University Amsterdam, Amsterdam, Netherlands; Arkin Institute for Mental Health, Amsterdam, Netherlands., de Jong PJ; Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, Netherlands., Nolen WA; University Medical Centre Groningen, Department of Psychiatry, University of Groningen, Groningen, Netherlands., Schene AH; Department of Psychiatry, Radboud University Medical Centre, and Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands., Hollon SD; Department of Psychology, Vanderbilt University, Nashville, TN, USA., Burger H; Department of General Practice, University of Groningen, Groningen, Netherlands. |
| المصدر: | The lancet. Psychiatry [Lancet Psychiatry] 2018 May; Vol. 5 (5), pp. 401-410. Date of Electronic Publication: 2018 Apr 03. |
| نوع المنشور: | Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't |
| اللغة: | English |
| بيانات الدورية: | Publisher: Elsevier Country of Publication: England NLM ID: 101638123 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2215-0374 (Electronic) Linking ISSN: 22150366 NLM ISO Abbreviation: Lancet Psychiatry |
| أسماء مطبوعة: | Original Publication: Kidlington, Oxford : Elsevier, [2014]- |
| مواضيع طبية MeSH: | Antidepressive Agents/*therapeutic use , Cognitive Behavioral Therapy/*methods , Depressive Disorder, Major/*drug therapy, Combined Modality Therapy/methods ; Female ; Humans ; Male ; Middle Aged ; Netherlands ; Psychotherapy/methods ; Recurrence ; Single-Blind Method ; Treatment Outcome |
| مستخلص: | Background: Keeping individuals on antidepressants after remission or recovery of major depressive disorder is a common strategy to prevent relapse or recurrence. Preventive cognitive therapy (PCT) has been proposed as an alternative to maintenance antidepressant treatment, but whether its addition would allow tapering of antidepressants or enhance the efficacy of maintenance antidepressant treatment is unclear. We aimed to compare the effectiveness of antidepressants alone, with PCT while tapering off antidepressants, or PCT added to antidepressants in the prevention of relapse and recurrence. Methods: In this single-blind, multicentre, parallel, three-group, randomised controlled trial, individuals recruited by general practitioners, pharmacists, secondary mental health care, or media were randomly assigned (10:10:8) to PCT and antidepressants, antidepressants alone, or PCT with tapering of antidepressants, using computer-generated randomised allocation stratified for number of previous depressive episodes and type of care. Eligible participants had previously experienced at least two depressive episodes and were in remission or recovery on antidepressants, which they had been receiving for at least the past 6 months. Exclusion criteria were current mania or hypomania, a history of bipolar disorder, any history of psychosis, current alcohol or drug abuse, an anxiety disorder that requires treatment, psychological treatment more than twice a month, and a diagnosis of organic brain damage. The primary outcome was time-related proportion of individuals with depressive relapse or recurrence in the intention-to-treat population, assessed four times in 24 months. Assessors were masked to treatment allocation, whereas physicians and participants could not be masked. This trial is registered with the Netherlands Trial Register, number NTR1907. Findings: Between July 14, 2009, and April 30, 2015, 2486 participants were assessed for eligibility and 289 were randomly assigned to PCT and antidepressant (n=104), antidepressant alone (n=100), or PCT with tapering of antidepressant (n=85). The overall log-rank test was significant (p=0·014). Antidepressants alone were not superior to PCT while tapering off antidepressants in terms of the risk of relapse or recurrence (hazard ratio [HR] 0·86, 95% CI 0·56-1·32; p=0·502). Adding PCT to antidepressant treatment resulted in a 41% relative risk reduction compared with antidepressants alone (0·59, 0·38-0·94; p=0·026). There were two suicide attempts (one in the antidepressants alone group and one in the PCT with tapering of antidepressants group) and one death (in the PCT and antidepressants group) not related to the interventions during the 24 months' follow-up. Interpretation: Maintenance antidepressant treatment is not superior to PCT after recovery, whereas adding PCT to antidepressant treatment after recovery is superior to antidepressants alone. PCT should be offered to recurrently depressed individuals on antidepressants and to individuals who wish to stop antidepressants after recovery. Funding: The Netherlands Organisation for Health Research and Development. (Copyright © 2018 Elsevier Ltd. All rights reserved.) |
| التعليقات: | Comment in: Lancet Psychiatry. 2018 May;5(5):380-381. (PMID: 29625763) Comment in: Evid Based Ment Health. 2019 Feb;22(1):e7. (PMID: 30530763) |
| المشرفين على المادة: | 0 (Antidepressive Agents) |
| تواريخ الأحداث: | Date Created: 20180408 Date Completed: 20190726 Latest Revision: 20190726 |
| رمز التحديث: | 20240628 |
| DOI: | 10.1016/S2215-0366(18)30100-7 |
| PMID: | 29625762 |
| قاعدة البيانات: | MEDLINE |
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