Relapse and recurrence prevention in depression: Current research and future prospects

Department of Psychology, University of Calgary, Alberta, Canada.
Clinical psychology review (Impact Factor: 7.18). 12/2011; 31(8):1349-60. DOI: 10.1016/j.cpr.2011.09.003
Source: PubMed


There is a growing body of literature which indicates that acute phases of psychotherapy are often ineffective in preventing relapse and recurrence in major depression. As a result, there is a need to develop and evaluate therapeutic approaches which aim to reduce the risk of relapse. This article provides a review of the empirical studies which have tested the prophylactic effects of therapy (cognitive-behavioral, mindfulness-based, and interpersonal psychotherapy) targeting relapse and recurrence in major depression. For definitional clarity, relapse is defined here as a return to full depressive symptomatology before an individual has reached a full recovery, whereas recurrence in defined as the onset of a new depressive episode after a full recovery has been achieved. Psychotherapeutic efforts to prevent relapse and recurrence in depression have been effective to varying degrees, and a number of variables appear to moderate the success of these approaches. A consistent finding has been that preventive cognitive-behavioral and mindfulness-based therapies are most effective for patients with three or more previous depressive episodes, and alternative explanations for this finding are discussed. It is noted, however, that a number of methodological limitations exist within this field of research, and so a set of hypotheses that may guide future studies in this area is provided.

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Available from: Shadi Beshai, Nov 29, 2014
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    • "ajor depression is the most common mental disorder, with an estimated lifetime prevalence of 13.5% to 21.2% (Hammar and Ardal, 2009). About 50% to 54% of depressed patients relapse within 2 years after remitting from their first episode, and up to 80% experience more than one depressive episode during their life (Beshai et al., 2011; Mueller et al., 1999). In addition to pervasively lowered mood, a depressive episode is associated with significant neurocognitive dysfunction . "
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    ABSTRACT: Major depression is the most prevalent psychiatric disorder with high relapse rates. When mood can improve or fully recover, the neurocognitive difficulties associated with depression often persist, preventing complete functional recovery. They have also been shown to predict relapse. The efficacy of neurocognitive remediation therapy (NCRT) to rehabilitate cognition has been demonstrated in several clinical populations but randomized controlled trials (RCTs) have not been conducted in depression. The present study aimed to test the feasibility and to conduct a pilot protocol testing for an RCT of computerized NCRT for inpatients with major depressive episode. The feasibility assessment demonstrated excellent acceptance of randomization and very satisfactory recruitment and compliance rates. The RCT procedures' assessment was overall consistent with a successful pilot study with the condition of protocol modification in terms of resources. Preliminary outcome data suggested specific NCRT efficacy to improve targeted neurocognitive processes in depression.
    The Journal of nervous and mental disease 07/2015; DOI:10.1097/NMD.0000000000000337 · 1.69 Impact Factor
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    • "Meditation has been shown to produce benefits for anxiety, depression, and other negative emotional symptoms (Jain et al., 2015; Simkin and Black, 2014). Review studies have pointed out that adding mindfulness meditation to conventional CBT offers a promising, cost-efficient psychological approach for preventing relapse/recurrence in recovered recurrently depressed patients (Beshai et al., 2011; Shelton, 2004). Prior exposure to mindfulness-based cognitive therapy (MBCT) appears to be about as efficacious as keeping patients on medications; in fact, most of the patients exposed to MBCT in one study were able to discontinue medications (Kuyken et al., 2008). "
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    ABSTRACT: Meditation has been increasingly evaluated as an important complementary therapeutic tool for the treatment of depression. The present study employed resting-state functional magnetic resonance imaging (rs-fMRI) to examine the effect of body-mind relaxation meditation induction (BMRMI) on the brain activity of depressed patients and to investigate possible mechanisms of action for this complex intervention. 21 major depressive disorder patients (MDDs) and 24 age and gender-matched healthy controls (HCs) received rs-fMRI scans at baseline and after listening to a selection of audio designed to induce body-mind relaxation meditation. The rs-fMRI data were analyzed using Matlab toolbox to obtain the amplitude of low-frequency fluctuations (ALFF) of the BOLD signal for the whole brain. A mixed-design repeated measures analysis of variance (ANOVA) was performed on the whole brain to find which brain regions were affected by the BMRMI. An additional functional connectivity analysis was used to identify any atypical connection patterns after the BMRMI. After the BMRMI experience, both the MDDs and HCs showed decreased ALFF values in the bilateral frontal pole (BA10). Additionally, increased functional connectivity from the right dorsal medial prefrontal cortex (dmPFC) to the left dorsal lateral prefrontal cortex (dlPFC) and the left lateral orbitofrontal cortex (OFC) was identified only in the MDDs after the BMRMI. In order to exclude the impact of other events on the participants׳ brain activity, the Hamilton Rating Scales for Depression (HDRS) was not measured after the body-mind relaxation induction. Our findings support the hypothesis that body-mind relaxation meditation induction may regulate the activities of the prefrontal cortex and thus may have the potential to help patients construct reappraisal strategies that can modulate the brain activity in multiple emotion-processing systems. Copyright © 2015 Elsevier B.V. All rights reserved.
    Journal of Affective Disorders 04/2015; 183. DOI:10.1016/j.jad.2015.04.030 · 3.38 Impact Factor
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    • "Some evidence has been found for alleviating chronic pain and depressive symptoms with collaborative care initiatives for chronic pain patients [56,57]. Collaborative care trials have proven their efficacy on sustained recovery of depressive disorder and continuation and maintenance therapies can reduce recurrence [58,59]. Tailored collaborative care interventions with maintenance therapies for patients who recovered from a depressive disorder but who are experiencing pain might reduce recurrence risk in this particular subpopulation of vulnerable patients. "
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    ABSTRACT: Background Studies suggest that poor physical health might be associated with increased depression and anxiety recurrence. The objectives of this study were to determine whether specific chronic diseases and pain characteristics are associated with depression and anxiety recurrence and to examine whether such associations are mediated by subthreshold depressive or anxiety symptoms. Methods 1122 individuals with remitted depressive or anxiety disorder (Netherlands Study of Depression and Anxiety) were followed up for a period of four years. The impact of specific chronic diseases and pain characteristics on recurrence was assessed using Cox regression and mediation analyses. Results Chronic diseases were not associated with recurrence. Neck (HR 1.45, p < .01), chest (HR 1.65, p < .01), abdominal (HR 1.52, p < .01) pain, an increase in the number of pain locations (HR 1.10, p < .01) and pain severity (HR 1.18, p = .01) were associated with an increased risk of depression recurrence but not anxiety. Subthreshold depressive symptoms mediated the associations between pain and depression recurrence. Conclusions Pain, not chronic disease, increases the likelihood of depression recurrence, largely through its association with aggravated subthreshold depressive symptoms. These findings support the idea of the existence of a mutually reinforcing mechanism between pain and depression and are indicative of the importance of shedding light on neurobiological links in order to optimize pain and depression management.
    BMC Psychiatry 06/2014; 14(1):187. DOI:10.1186/1471-244X-14-187 · 2.21 Impact Factor
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