Cognitive therapy can have a preventive effect for depression

Aug 4 2005

Three years ago, Terry Tuton was laid off from his job as project manager at a large technology firm, leaving him limited insurance coverage at a time when he was suffering from overpowering feelings of hopelessness and depression - and not for the first time in his life. Overwhelmed and unsure where to turn, he happened upon a small advertisement seeking participants for a UT Southwestern Medical Center research study on recurrent depression.

Today, the 51-year-old real estate agent credits his participation in the clinical trial - which focuses on cognitive therapy - with turning his life around.

"When I started the study, the depression was as severe as any I've suffered in my life," Mr. Tuton said. "I was at the point that I didn't know what to do about it any more or how to cope."

Since completing the study last March, Mr. Tuton has learned how to better understand and combat his disease - major depressive disorder (MDD) - as well as how to pinpoint behaviors and thoughts that often trigger the depression's downward cycle. Just like patients who suffer from other physical ailments such as migraines or high blood pressure, depressed individuals can learn to recognize warning signs of depression and develop action plans to help prevent it, shorten it or lessen its impact.

"It was remarkable. The study changed my life," Mr. Tuton said. "It took me 50 years to figure this out. You can't imagine how different I feel now, knowing that there is never going to be that hopelessness again. I feel positive about my life, probably for the first time." Between 50 percent and 85 percent of people with MDD experience a relapse or recurrence within two years after recovering from a depressive episode. Past research suggests that about 50 percent to 85 percent of these patients improve when treated with cognitive therapy, a "talking" therapy that focuses on changing negative patterns of thinking and developing coping skills.

UT Southwestern's current study offers 16 to 20 sessions of cognitive therapy over a 12-week period, with some patients then randomly assigned for additional "booster" sessions of cognitive therapy, antidepressant medication or pill placebos.

"The purpose of our research is to evaluate which treatments can keep patients well for the longest intervals," said Dr. Robin Jarrett, professor of psychiatry at UT Southwestern. "Until there is a cure for depression, we will continue to develop and identify treatments which prevent relapse and recurrence, and promote and sustain remission and recovery. For many individuals, cognitive therapy can have a preventive effect."

Principal investigator for the clinical trial, Dr. Jarrett has designed and directed numerous studies examining the effectiveness of interventions for depression, including cognitive therapy compared to or used with antidepressant medications for treating the initial onset of the disease, as well as future occurrences.

For Mr. Tuton, cognitive therapy helped him track and identify behaviors he could try to change, such as his desire for perfection. "Everything I did had to be perfect. And because it couldn't be, I would beat myself up over it, and it would start a cycle of depression. Learning that fact was key in breaking that cycle. I learned that I only have to do things as well as I can, not perfectly."

Mr. Tuton says he doesn't believe he will ever be completely cured of depression - a disease he suffered even as a child - but he does now know how to fight it. "When I suffer from depression now, it's much, much shorter in duration and nowhere near as deep as it was. I know how to combat it and what to do.

"People who don't suffer from depression don't understand. They think it's a matter of 'sucking up' and getting over it, or looking on the bright side or keeping a stiff upper lip," he said.

UT Southwestern is one of two sites recruiting more than 500 individuals for the research study funded by grants from the National Institute of Mental Health. Eligible participants must be ages 18 to 70, have experienced at least two episodes of MDD and not currently be under psychiatric treatment. They also must have no current history of alcohol or drug dependence.