Psychotherapies — particularly cognitive-behavioral approaches used as adjunctive treatments — can play a critical role in helping people with a history of depression avoid relapse.
For many people, major depression is a chronic illness. Even when they are no longer depressed, people who have had several episodes of depression have to be concerned about a significant risk of a recurrence of depression.
The risk of another episode increases with each new episode, which highlights the importance of strategies designed to prevent recurrence. Most guidelines emphasize the importance of continued antidepressant treatment, but few discuss the potential role of psychotherapy.
In a meta-analysis of 11 randomized, controlled trials of psychotherapy given to people who had recovered from depression, Breedvelt assessed the efficacy of evidence-based psychotherapy (generally either cognitive-behavioral therapy [CBT] or mindfulness-based CT), as either an alternative to antidepressants or an addition to antidepressant medication.
In six studies (n=948), psychotherapy without antidepressants (antidepressant was tapered off in 5 studies) yielded the same relapse risk as continued antidepressants. It is perhaps worth noting that mindfulness based therapies appeared to be more effective under these conditions than cognitive therapy.
In seven studies (n=611), the addition of psychotherapy to continued antidepressants was associated with a 15% lower risk for relapse than antidepressants alone.
It is important to note that people who want to use psychotherapy should identify therapists with gold-standard psychotherapy training (i.e., CBT, or mindfulness-based cognitive therapies). Many community therapists have “eclectic” styles employing a mix of treatment elements that might not produce the results observed here.
Breedvelt JJF et al. Psychological interventions as an alternative and add-on to antidepressant medication to prevent depressive relapse: Systematic review and meta-analysis. Br J Psychiatry 2020 Nov 18; [e-pub]. (https://doi.org/10.1192/bjp.2020.198)