Cognitive Therapy, Meds Equal in Curbing Depression Relapse

Patients treated for depression who are at high risk for relapse after responding to an acute phase of cognitive therapy (CT) are just as likely to avoid relapse via continuation phase cognitive therapy (C-CT) or by switching to an antidepressant regimen with medication management, new research suggests.

Of 241 at-risk patients randomly assigned to receive 8 months of continuation phase treatment after receiving 12 to 14 weeks of acute-phase CT, 33% of the 69 assigned to pill placebo relapsed into depression compared with approximately 18% of the 86 who went on to receive C-CT and with 18% of the 86 who were switched to continuation phase treatment with the antidepressant fluoxetine.

Robin B. Jarrett, PhD, University of Texas Southwestern Medical Center, in Dallas, and Michael Thase, MD, now at University of Pennsylvania, and colleagues (at the University of Pittsburgh), collaborated on the randomized, controlled trial to extend Dr. Jarrett’s initial finding of C-CT efficacy in preventing relapse relative to an assessment-only control. The finding that receiving C-CT prevented relapse more than pill placebo shows that another site (the University of Pittsburgh) can achieve its preventive effects.

Although the researchers expected that both active therapies would reduce the risk for relapse, they had anticipated that C-CT would have a more durable benefit ― that is, to prevent recurrence during the first year ― compared to the medication comparator. The study was powered for this comparison after active treatments were discontinued.

“Contrary to prediction, we found no evidence to support the hypothesis that C-CT conveys more enduring prophylaxis in acute phase CT responders than fluoxetine after continuation phase treatments are stopped,” the investigators write.

Relapse Predictor

Patients were identified as susceptible to relapse/recurrence by demonstrating a delayed, unstable, or partial response in the acute-treatment-phase CT. The researchers prospectively applied an algorithm from Dr. Jarrett’s earlier study to detect heightened risk, with parameters that included at least 1 rating score of 7 or higher on the 17-item Hamilton Rating Scale for Depression (HRSD-17) during the final 7 weekly assessments. Dr. Thase’s group had also previously shown this effect with a somewhat distinct algorithm.

“Those with the partial remission were viewed to be at high risk for relapse and recurrence, and that finding is basically one of the most robust findings in psychiatry ― that partial remission or unstable remission does forecast a later relapse and recurrence,” Dr. Jarrett told Medscape Medical News.

In an earlier comparison of sequential treatments, with acute-phase antidepressant treatment followed by either a maintenance antidepressant regimen, pill placebo, or a group-based cognitive therapy (Mindfulness-Based Cognitive Therapy), Zindel Segal, PhD, University of Toronto, Canada, and colleagues had also found that medication and cognitive therapy were comparable in reducing relapse/recurrence.

Commenting on the current study for Medscape Medical News, Dr. Siegel, who was a consultant on the Jarrett-Thase trial, said, “The increasing interest in sequential treatment of mood disorder is a response to 2 phenomena ― high rates of medication discontinuation or reduced antidepressant tachyphylaxis and the need to reduce residual risk for relapse/recurrence. Utilizing a sequenced 2-stage treatment algorithm can provide intervention for the acute depressive episode as well as targeted prevention benefits against episode return.”

“To date,” said Dr. Segal, “very few studies have evaluated this model, and the Jarrett et al study provides unique data to address this question. Their finding that C-CT or fluoxetine in acute-phase CT responders provides greater prophylaxis than placebo demonstrates the value of the second step in a sequenced approach.”

Research Gap

The investigators describe their study as being not only the first to demonstrate that an antidepressant medication regimen significantly reduces the risk for relapse/recurrence for patients who first received psychotherapy but also the largest study of relapse prevention strategy applied after acute-phase CT.

“So there was a huge gap in the literature with respect to having psychotherapy first,” Dr. Jarrett elaborated. “Nobody had ever showed that psychotherapy responders would actually accept medication as a way of preventing depression. In addition, patients need an array of choices. Continuation phase cognitive therapy is an effective choice in preventing relapse as an immediate intervention for high-risk responders.”

The question of whether medication intervention would be accepted by patients who initially sought CT did appear to surface in the attrition data from Dr. Jarrett’s study. Although the final attrition rates after 8 months did not statistically differ between the groups, significantly more patients from the medication and placebo combined groups (n = 13) than from the C-CT group (n = 1) left the study before the first continuation-phase session.

Dr. Jarrett noted that this early attrition from those assigned to medication and placebo groups did not affect the final analysis of the superiority of both active treatments relative to placebo, but she explained that “this sample is biased in that the people who went into this study wanted psychotherapy, they wanted cognitive therapy. They didn’t prefer medication, or they would have started with that approach.”

The researchers’ next steps include delving more into the characteristics of risk for depression.

Causes and symptoms of Clinical Depression in an individual

The persistent feeling of sadness, being moody or feeling low for a long time is generally termed as depression in an individual. This can be for several weeks or even several months and is a long term syndrome. This does not only take a toll on the person’s mental situation but also on his physical condition. In such cases people stop interacting with the outside world, stop eating etc. This worsens their condition.  This syndrome makes people lose interest in their work and all sorts of other activities. You may develop a constant feeling of irritation within you and you seem to lose all concentration in work.

What exactly is Clinical Depression?

Clinical Depression

Clinical depression in a person is generally noticed when a person stays depressed throughout the day and is unable to concentrate in his work at any point of time. Generally people undergoing clinical depression seem to face this problem on a minimum basis of twice a day. The most common symptoms that are experienced by a person going through clinical depression are:

  • A constant feeling of energy loss throughout the day.
  • A persistent feeling of guilt that seems to evade the mind of the individual.
  • A significant and abnormal amount of weight loss.
  • Impaired concentration.
  • Constant feelings of committing suicide or harming oneself.
  • Restlessness or constant feeling of irritation.
  • Insomnia or passing sleepless nights.

These symptoms can become severe enough to make you react awkwardly in different situations. It can hamper your relation and make you spoil things badly. You may not be able to control you own feelings or be unaware of it at certain point of time. Clinical depression can be a result of anxiety or some form of shock that the person has received at some point of time. The intensity of the depression generally depends on the magnitude of the shock received by the person. If the incident is a minor one the person may recover in a short period of time. But in case of major incidents individuals may get into a long term depression.

Ways to cure Clinical Depression:

There are several ways in which clinical depression can be cured. The most common one is through the method of constant counseling though it depends on the magnitude of the shock received by the person. There are a number of counselors who counsel people through this and help them come back to their normal lives. It is very important for people related to a person suffering from clinical depression to provide the individual with an environment that will help him or her forget the reason of their agony. It is important for the individual to forget the incidents that have been the reason of his or her situation. Anti-depressant medications are also a way to cure such patients. In case an individual’s cannot be cured through verbal counseling, doctors opt for medication for these patients. Patients who suffer from such long term depression can be a threat to both themselves and to the people around them.


It will not be possible for a common man to realize the situation of a person going through such depressions. People seem to lose every bit of their normal sense. These patients need intense care and love to come out of situations. Unwanted circumstances and problems can result in the extension of these symptoms in the person.

Bipolar Disorder – a closer look at this deadly mood disorder

Bipolar disorder is a form of mood disorder that is often characterized by strange moods. Most people who experience it keep flitting between states of mania to extreme depression. It can be very damaging to the lives of people who suffer from this condition and it’s not only the patients but also the people around them who suffer. One in 70 people tend to suffer from it and it greatly affects their personal lives, work lives and relationships with everyone around them due to this mood disorder.

Bipolar Disorder – a closer look at this deadly mood disorder

To be able to understand this disorder accurately we need to define what mood is and what conditions can cause a mood disorder. Moods are known to define our state of mind at any given time and they can be defined as good moods and bad moods depending on how they make us feel. It can be anything from happiness to agony and your mood is known to be an emotional barometer and it defines your feelings. Moods measure our comfort or discomfort with ourselves and others. Every single person’s mood varies from time to time and they are not in control of their emotions always and ups and downs are quite natural. However, there is a noticeable difference in what normal people suffer from and what people suffering from bipolar misery suffer every single day.

Bipolar mood disorder and its relation with mania and depression

Previously, bipolar disorder was lumped in with normal despondency, researchers propose that there are critical contrasts between the two, particularly with regards to prescribed medications. A great many people with bipolar misery are not helped by antidepressants. Indeed, there is a danger that antidepressants can aggravate bipolar issue—activating lunacy or hypomania, bringing on fast cycling between inclination states, or meddling with other disposition balancing out medications.

Bipolar Disorder – a closer look at this deadly mood disorder

In the hyper period of bipolar issues, sentiments of uplifted vitality, imagination, and rapture are normal. Individuals encountering a hyper scene regularly talk at an impressive rate, rest practically nothing, and are hyperactive. They might likewise feel like they’re almighty, strong, or bound for significance.

In any case, while insanity feels great at in the first place, it tends to winding wild. Individuals frequently carry on carelessly amid a hyper scene: betting endlessly, taking part in unseemly sexual action, or making absurd business ventures, for instance. They might likewise get to be irate, crabby, and forceful—starting quarrel, lashing out when others don’t oblige their arrangements, and faulting any individual who condemns their conduct. A few individuals even get to be whimsical or begin listening to voices.

Notwithstanding numerous likenesses, certain indications are more basic in bipolar sadness than in consistent depression. For instance, bipolar dejection will probably include touchiness, blame, flighty emotional episodes, and sentiments of anxiety. Individuals with bipolar misery likewise tend to move and talk gradually, rest a great deal, and put on weight. Furthermore, they will probably create crazy melancholy—a condition in which they’ve lost contact with reality—and to experience significant incapacity in work and social environments.


Bipolar Disorder – a closer look at this deadly mood disorder

On the off chance that you detect the unusual and common symptoms of bipolar issues in yourself or another person, don’t hold up to get help. Disregarding the issue won’t make it go away; actually, it will more likely than not deteriorate. Living with untreated bipolar issue can prompt issues in everything from your profession to your connections to your wellbeing. Diagnosing mood disorder as ahead of schedule as could be expected under the circumstances and getting into treatment can keep these difficulties.

In case you’re hesitant to look for treatment in light of the fact that you like the way you feel when you’re hyper, recall that the vitality and elation accompany a cost. Madness and hypomania frequently turn dangerous, harming you all your loved ones and people you meet on a daily basis.

Symptoms and effects for Atypical Depression

Any type of depression will make you feel unhappy and miserable and keep you from appreciating life in its fullest. Nevertheless, atypical depression which is also termed as depression with atypical characteristics is the kind of disorder that your unhappy mood can brighten in reaction to positive events. Some important symptoms include amplified appetite, over sleeping, feeling weight in your body, and feeling completely rejected.

In spite of its unusual name, atypical depression is not rare or uncommon. It usually affects how you sense things and events consider and react, and this can lead to emotional and other health related problems. You can generally have distress during attending to normal day to day activities, and occasionally you can even feel as though life is not worth living.

Atypical Depression

This type of depression is a sub type of major depression that includes in a lot of cases numerous specific symptoms, including increased appetite and weight increase, excessive sleep all through the day, noticeable fatigue, tiredness or weakness, moods swings that are powerfully responsive to surrounding circumstances, and feeling enormously sensitive to rejection. Atypical depression can be an indicator for both major depression and dysthymic disorder. Individuals suffering from atypical depression have frequently had episodes of depression mainly at a very early age, during their teenage years.

Symptoms of any type depression can differ from person to person based on circumstances. Important signs and symptoms of atypical depression includes the following

  1. A sudden increase in appetite that can cause massive weight advancement
  2. Increased longing to sleep a lot throughout the day, frequently more than 10 hours a day.
  3. Unhappiness and depressive mood that momentarily revitalizations to brighter moods in reaction to happy news or positive events.
  4. Feeling heavy in your arms and legs. Difficulty to do any activity because of the weight in arms and legs.
  5. Higher sensitivity and fear of rejection that causes a lot of strain in relationships and social life. It can even affect your work life.

Other symptoms of atypical depression also may include the following. They are not key symtoms but they to have an adverse effect on the person

Sleeplessness or insomnia all through the night

  1. Highly disorderly eating. Binging and starving in a cycle and other eating disorderly eating habits like bulimia and Restrictive Food Intake Disorder.
  2. Extremely poor body image issues and unhappiness on feeling fat and unattractive.
  3. Body pains, Headaches and other health issues.

Dysthymic disorder is a psychological condition concerning the continuance of a unhappy and depressed temperament for a lot of days, that is at least a two year time period in adults and at least a year in children and teenagers in addition to at least two of the above mentioned symptoms, but a little lesser than the five symptoms which define a the same disorder.

Treatments for Atypical Depression

Medications and psychotherapy are the most operative treatments for most people with any type depression, which includes this type of depression. Consult your family doctor or primary doctor or psychiatrist who can prescribe drugs and medications to improve the disorder. Nevertheless, a lot of people with this type of depression also get assistance from a psychologist, therapist or other mental health professional who can help with the situation. Sometimes in a few cases in case of severe depression symptoms and suffer from suicidal thoughts, you may need to be hospitalized for a few days. In other cases you may also be required to partake in outpatient treatment operations until your symptoms improve.

Persistent Depressive Disorder, Dysthymia, and Chronic Depression: Update on Diagnosis, Treatment

Since the classic descriptions, depression has been conceived as an episodic and recurrent illness. Depressive episodes with clear onset and offset and sharp contrast with one’s usual mood and behaviors are perhaps the most conspicuous feature of severe mood disorders. However, systematic studies of unselected samples have been telling a different story: a large proportion of individuals suffer from low mood, lack of interest, and other symptoms of depression chronically, with some fluctuations but no clearly demarcated episodes.1 Chronic patterns of symptoms are often under-recognized and undertreated in the community.2

This article provides an update on the diagnosis, causation, and treatment of chronic depressive problems, with a focus on the recently introduced diagnostic category of persistent depressive disorder (PDD).


In DSM-III and DSM-IV, the protracted forms of depression have been conceptualized as dysthymia and by the chronic specifier of major depressive episodes. Dysthymia was characterized by milder symptoms not fully meeting criteria for MDD, but lasting 2 years or longer and meriting clinical attention because of the cumulative burden of long-standing symptoms. The symptomatic criteria for dysthymia differed in part from those for major depressive episode, with an emphasis on low self-esteem and hopelessness.

In DSM-III and DSM-IV, dysthymia was trumped by MDD and was only diagnosed if the threshold for a major depressive episode was not met in the initial 2 years of symptoms. Major depressive episodes could be specified as chronic if the full criteria were continuously met for 2 years or longer.

The validity of dysthymia and its separation from MDD has been repeatedly discussed and questioned.3 When individuals with dysthymia were followed over long periods, it became clear that most of them also developed major depressive episodes, which suggests that dysthymia and major depressive episodes are phases of the same disorder rather than separate conditions.4 Dysthymia and MDD also run in the same families and respond to the same treatments. On the other hand, both dysthymia and chronic depression are associated with more impairment, comorbidity, and suicide risk than less persistent forms of depression.5

Chronic depression and dysthymia were merged into PDD in DSM-5. This new division of depressive disorders gives more weight to duration than to severity of symptoms. DSM-5 defines PDD on the basis of the set of symptoms for dysthymia, with the assumption that most individuals who meet the full symptoms for MDD also meet criteria for dysthymia. However, because of differences in symptomatic criteria, some individuals with chronic major depressive episodes will not meet the DSM-5 criteria for PDD.6

While the merger of dysthymia and chronic depression into PDD is well justified by their strong sequential comorbidity and similar implications for prognosis and treatment, several aspects of the new diagnosis are not well supported by evidence and may not be useful. Why do we need 2 different sets of symptomatic criteria for MDD and PDD? The reliability and validity of the dysthymia criteria has not been formally tested, prompting concerns about the value of the new diagnosis.3

The assumption that most individuals with chronic depression also fulfill the dysthymia criteria may not hold consistently enough—it creates a group of individuals who suffer from chronic depression but do not receive the PDD diagnosis. While it is undisputable that prolonged duration and nonepisodic character are relevant, there is no good justification for the 2-year cutoff. In fact, some of the work used to justify the validity of persistent depression is based on a duration of 1 year or longer.7 For clinical and prognostic purposes, it is important to emphasize that duration of depressive symptoms is important both below and above the 2-year mark regardless of whether the depression or dysthymia/PDD criteria are met.