Relapse prevention strategies for recurrent depression

Depression is a recurrent disorder with a substantial disease burden for individuals and society. Given the high relapse/recurrence rates, especially for individuals with previous depressive episodes, relapse prevention is of paramount importance. This dissertation focused on current gaps in the knowledge of relapse prevention. We developed and validated a tool to predict relapse/recurrence risk for an individual and concluded that more studies are needed to enhance the performance before implementing it into clinical practice. We also explored beliefs about the causes of depression and recovery (i.e., causal beliefs) and whether they predicted antidepressant use in terms of adherence, dosage, and successful tapering antidepressants, which was not the case. In addition, we examined several relapse prevention strategies for individuals remitted from at least two depressive episodes. We found that adding Preventive Cognitive Therapy (PCT) to long-term antidepressants had positive effects on depressive relapse/recurrence over 24 months and was cost-effective compared to continuing antidepressants. Continuing antidepressants was not superior compared to PCT while tapering antidepressants but was cost-effective. Adding an internet-based version of PCT with minimal therapist support to Treatment As Usual (TAU) was neither effective nor cost-effective over 24 months compared to TAU alone. The most important clinical implications of the studies are that face-to-face PCT as started after recovery on antidepressants is recommended and that PCT might form an alternative for individuals with a wish to taper antidepressants, but that extra costs might be involved when tapering antidepressants