Psychotherapy in recurrent depression: efficacy, pitfalls, and recommendations

ABSTRACT

Introduction

Most people who seek treatment for depression experience relapse or recurrence, thus prevention represents a very important way to reduce suffering and burdens associated with this illness.

Areas covered

Preventive psychological interventions after depression remission include maintenance psychotherapy after an initial course of psychological treatment and the sequential model, i.e. the use of psychotherapy after pharmacotherapy or the application of drug treatment after a course of psychotherapy. Maintenance psychotherapy is aimed to prolong the effects obtained in the previous treatment course. The sequential model appeared to be more effective than monotherapy or the simultaneous combination of two different interventions.

Expert opinion

The patient should be informed about the prognosis of depressive illness and treatment options. One option would be to continue with an antidepressant drug indefinitely; however, loss of clinical effect may occur. The other option would be to start working on the prevention of the next episode. Thus, a sequential approach might be proposed. It includes antidepressants in the acute phase and a short-term course of cognitive-behavioral therapy in the residual phase. This approach has been specifically applied for its preventive effects. Completing the psychotherapy course with sessions of Well-Being Therapy would be optimal to enhance psychological well-being and euthymia.

KEYWORDS:

• Antidepressant
• depression
• psychotherapy
• recurrence
• relapse

Article highlights

• Relapse in depression is a challenging clinical condition in need of treatment

• Maintenance with antidepressants in recurrent depression has been questioned

• Treatment options currently available include maintenance psychotherapy and a sequential model which integrates psychotherapy and pharmacotherapy

• Maintenance psychotherapy is aimed to prolong the effects obtained in the previous treatment course

• The sequential model appears to be particularly indicated in recurrent depression

• Completing the psychotherapy course with sessions of well-being therapy would be optimal

• The patient should be informed about the prognosis of depressive illness and its treatment options

• Treatments options should be provided based on an analysis of advantages and disadvantages

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.