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CBT for major depression may continue to reduce relapse in the long term

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Question In patients who have been successfully treated for major depressive disorder and whose antidepressant doses are being tapered, is cognitive behavioural therapy (CBT) better than standard clinical management (CM) for preventing relapse?

Design

Randomised controlled trial with 6 years of follow up.

Setting

{An affective disorders programme in Bologna, Italy.}*

Patients

{43 patients were enrolled, and 40 (93%) were analysed (mean age 46 y, 68% women).}* Patients met the Research Diagnostic Criteria (RDC) for primary major depression and were treated for ≥3 months with full doses of antidepressants. {Exclusion criteria were an unsuccessful response to antidepressants; current medical illness; and history of manic, hypomanic, or cyclothymic features; substance abuse; personality disorder; or antecedent dysthymia.}*

Intervention

{After pharmacological treatment}*, patients were allocated to CBT (n=20) or standard CM (n=20). Antidepressants were tapered {at the rate of 25 mg of amitriptyline (or its equivalent) every other week}* and stopped. {CBT and CM consisted of 10 sessions of 40 minutes once every other week.}* Further psychotherapy, drugs, or both, were not permitted during follow up unless a relapse occurred. {A psychiatrist treated …

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