Monthly therapy keeps depression at bay for some

By Anne Harding

NEW YORK (Reuters Health) - Women who recover from depression with the help of psychotherapy alone can stay well for as long as two years with monthly "maintenance" therapy, a new study shows.

"Once people are well, that's probably all they need to keep well," Dr. Ellen Frank of the Western Psychiatric Institute and Clinic in Pittsburgh, the study's lead author, told Reuters Health. "It may even be that even less than once a month would work, but we don't know that from this study."

However, Frank and her team found that women who had required antidepressant medication to beat their depression, and then stopped taking the antidepressants, had a tougher time staying well when they relied on therapy alone for maintenance treatment.

The researchers set out to investigate whether more frequent psychotherapy sessions would be more effective for preventing depression relapse than monthly treatment. They describe the results in the American Journal of Psychiatry.

At the study's outset, 233 women with recurrent depression underwent treatment for 12 to 24 weeks with therapy only or therapy plus antidepressants. Among women who recovered, those who were on therapy alone continued for an additional 17 weeks, and, if they continued to be in remission, were randomly assigned to weekly therapy, twice monthly therapy, or monthly therapy. Those who were on therapy and taking antidepressants continued their treatment for 20 weeks, and were randomly assigned to one of the three therapy frequency groups after going off medication.

Weekly or twice-monthly therapy was no better than monthly therapy for helping women stay depression-free, the researchers found.

It was also tougher for women in remission to stick to the weekly schedule, Frank noted in an interview.

The women who had taken antidepressants were much more likely to experience a recurrence of depression, the researchers found. During the continuation phase of the study, after remission had occurred, 50 percent of those who remained in the study experienced a relapse, compared to 26 percent of the women who were on psychotherapy alone.

"This report now adds to the accumulating data supporting the necessity of pharmacologic maintenance treatment in individuals who require therapy to achieve remission," the team points out.

There's also mounting evidence that people who can focus strongly on interpersonal issues during therapy are most likely to be helped by it, Frank noted. People who don't do as well tend to have more anxiety and physical complaints, she added, which may make it more difficult to move the focus away from how they feel physically to their mental and intrapersonal state.

SOURCE: American Journal of Psychiatry, May 2007.