Skip to main content

Advertisement

SpringerLink
Log in

Antidepressant Medication Status as a Moderator of Winter Depression Recurrence Following Cognitive-Behavioral Therapy and Light Therapy: Is There Evidence of an Iatrogenic Effect?

  • Brief Report
  • Published:
Cognitive Therapy and Research Aims and scope Submit manuscript

Abstract

Hollon (Am Psychol 75(9):1207–1218, 2020) questioned whether antidepressant medication (ADM) has iatrogenic effects that prolong a depressive episode, contributing to relapse when ADM is stopped and explaining the apparent enduring advantage of cognitive-behavioral therapy (CBT) over ADM in reducing risk of recurrence. A randomized clinical trial including 177 adults with winter depression treated with 6 weeks of CBT or light therapy (LT) observed significantly fewer depression recurrences the second winter following CBT than LT, but not the first winter after treatment. Stable ADM use at baseline was allowed, with ADM status tracked at each followup. In logistic regression analyses, neither study treatment-baseline ADM status (CBT, CBT + ADM, LT, LT + ADM) nor ADM status at followup (present/absent) significantly predicted recurrence at either followup, and there were no significant interactions of these variables at either followup. After adjustment for ADM status at second winter, the likelihood of recurrence at second winter was (1) lower in CBT than in LT, among participants without and with baseline ADM (0.43X and 0.56X lower, respectively), and (2) not significantly different for those taking vs. not taking ADM at baseline in either CBT or LT. Results support an enduring effect of CBT, but not iatrogenic effects of ADM in this study.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Data Availability

Data are available on request from the authors.

References

  • Andrews, P. W., & Thomson, J. A. Jr. (2009). The bright side of being blue: Depression as an adaptation for analyzing complex problems. Psychological Review, 116(3), 620–654. https://doi.org/10.1037/a0016242.

    Article  PubMed  PubMed Central  Google Scholar 

  • Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. Guilford Press.

    Google Scholar 

  • Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the beck depression inventory-second edition. Psychological Corporation.

    Google Scholar 

  • Cuijpers, P., Hollon, S. D., van Straten, A., Bockting, C., Berking, M., & Andersson, G. (2013). Does cognitive behaviour therapy have an enduring effect that is superior to keeping patients on continuation pharmacotherapy? A meta-analysis. British Medical Journal Open, 3(4), e002542. https://doi.org/10.1136/bmjopen-2012-002542.

    Article  Google Scholar 

  • DeRubeis, R. D., Zajecka, J., Shelton, R. C., Amsterdam, J. D., Fawcett, J., Xu, C., & Hollon, S. D. (2020). Prevention of recurrence after recovery from a major depressive episode with antidepressant medication alone or in combination with cognitive behavior therapy: phase 2 of a 2-phase randomized clinical trial. JAMA Psychiatry, 77(3), 237–245. https://doi.org/10.1001/jamapsychiatry.2019.3900.

    Article  PubMed  Google Scholar 

  • First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (1995). Structured clinical interview for DSM-IV axis I disorders (clinician version). New York, NY: New York State Psychiatric Institute Biometrics Department.

  • Hollon, S. D. (2020). Is cognitive therapy enduring or antidepressant medications iatrogenic? Depression as an evolved adaptation. American Psychologist, 75(9), 1207–1218. https://doi.org/10.1037/amp0000728.

    Article  PubMed  Google Scholar 

  • Hollon, S. D., Andrews, P. W., Singla, D. R., Maslej, M. M., & Mulsant, B. H. (2021). Evolutionary theory and the treatment of depression: it is all about the squids and the sea bass. Behaviour Research and Therapy, 143, 103849. https://doi.org/10.1016/j.brat.2021.103849.

    Article  PubMed  Google Scholar 

  • Hollon, S. D., DeRubeis, R. J., Andrews, P. W., & Anderson Thomson, J. Jr. (2021). Cognitive therapy in the treatment and prevention of depression: a fifty-year retrospective with an evolutionary coda. Cognitive Therapy and Research, 45, 402–417. https://doi.org/10.1007/s10608-020-10132-1.

    Article  Google Scholar 

  • Hollon, S. D., DeRubeis, R. J., Fawcett, J., Amsterdam, J. D., Shelton, R. C., Zajecka, J., & Gallop, R. (2014). Effect of cognitive therapy with antidepressant medications vs. antidepressants alone on the rate of recovery in major depressive disorder: a randomized clinical trial. JAMA Psychiatry, 71(10), 1157–1164. https://doi.org/10.1001/jamapsychiatry.2014.1054.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lewy, A. J., Sack, R. L., Singer, C. M., Whate, D. M., & Hoban, T. M. (1988). Winter depression and the phase-shift hypothesis for bright light’s therapeutic effects: history, theory, and experimental evidence. Journal of Biological Rhythms, 3(2), 121–134. https://doi.org/10.1177/074873048800300203.

    Article  CAS  PubMed  Google Scholar 

  • Rohan, K. J. (2008). Coping with the seasons: a cognitive-behavioral approach to seasonal affective disorder: therapist guide. Oxford University Press.

    Chapter  Google Scholar 

  • Rohan, K. J., Evans, M., Mahon, J. N., Sitnikov, L., Ho, S. Y., Nillni, Y. I., & Vacek, P. M. (2013). Cognitive-behavioral therapy vs. light therapy for preventing winter depression recurrence: study protocol for a randomized controlled trial. Trials, 14, 82. https://doi.org/10.1186/1745-6215-14-82.

    Article  PubMed  PubMed Central  Google Scholar 

  • Rohan, K. J., Mahon, J. N., Evans, M., Ho, S., Meyerhoff, J., Postolache, T. T., & Vacek, P. M. (2015). Randomized trial of cognitive-behavioral therapy versus light therapy for seasonal affective disorder: acute outcomes. The American Journal of Psychiatry, 172(9), 862–869. https://doi.org/10.1176/appi.ajp.2015.14101293.

    Article  PubMed  PubMed Central  Google Scholar 

  • Rohan, K. J., Meyerhoff, J., Ho, S., Evans, M., Postolache, T. T., & Vacek, P. M. (2016). Outcomes one and two winters following cognitive-behavioral therapy or light therapy for seasonal affective disorder. The American Journal of Psychiatry, 173(3), 244–251. https://doi.org/10.1176/appi.ajp.2015.15060773.

    Article  PubMed  Google Scholar 

  • Rohan, K. J., Rough, J. N., Evans, M., Ho, S., Meyerhoff, J., Roberts, L. M., & Vacek, P. M. (2016). A protocol for the hamilton rating scale for depression: item scoring rules, rater training, and outcome accuracy with data on its application in a clinical trial. Journal of Affective Disorders, 200, 111–118. https://doi.org/10.1016/j.jad.2016.01.051

    Article  PubMed  PubMed Central  Google Scholar 

  • Williams, J. B. (1988). A structured interview guide for the hamilton depression rating scale. Archives of General Psychiatry, 45(8), 742–747. https://doi.org/10.1001/archpsyc.1988.01800320058007

    Article  CAS  PubMed  Google Scholar 

  • Williams, J. B., Link, M. J., Rosenthal, N. E., Amira, L., & Terman, M. (1992). Structured interview guide for the hamilton depression rating scale—seasonal affective disorder version (SIGH-SAD). State Psychiatric Institute.

    Google Scholar 

  • Willeit, M., Sitte, H. H., Thierry, N., Michalek, K., Praschak-Rieder, N., Zill, P., Winkler, D., Brannath, W., Fischer, M. B., Bondy, B., Kasper, S., & Singer, E. A. (2008). Enhanced serotonin transporter function during depression in seasonal affective disorder. Neuropsychopharmacology : Official Publication Of The American College Of Neuropsychopharmacology, 33(7), 1503–1513. https://doi.org/10.1038/sj.npp.1301560.

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

This work was supported, in part, by Grant No. R01MH078982 from the National Institute of Mental Health to Kelly J. Rohan.

Author information

Authors and Affiliations

  1. Department of Psychological Science, University of Vermont, John Dewey Hall, 2 Colchester Avenue, Burlington, VT, 05405-0134, USA

    Kelly J. Rohan, Julia M. Terman, Richard J. Norton & Beth M. McCormick

  2. Biomedical Statistics Research Core, University of Vermont Larner College of Medicine, 25 Hills Building, 111 Colchester Avenue, Burlington, VT, 05401-0134, USA

    Pamela M. Vacek & Michael J. DeSarno

Authors
  1. Kelly J. Rohan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Julia M. Terman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Richard J. Norton
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Beth M. McCormick
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Pamela M. Vacek
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Michael J. DeSarno
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. KJR: secured funding for the parent project and wrote the first draft of the manuscript. MJD and PMV: performed data analysis. All authors commented on previous versions of the manuscript and approved the final manuscript.

Corresponding author

Correspondence to Kelly J. Rohan.

Ethics declarations

Conflict of Interest

Kelly J. Rohan has received and currently receives funding from the National Institute of Mental Health and receives book royalties from Oxford University Press for the treatment manual for the cognitive-behavioral therapy for SAD intervention. The other authors declare they have no financial or non-financial interests to disclose.

Ethical Approval

The research study is a secondary analysis of data obtained in a randomized clinical trial. The parent trial was approved by the Institutional Review Board at the University of Vermont. All procedures performed in this study were in accordance with the ethical standards of the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was collected from all individual participants in the study.

Animal Rights

No animal studies were carried out by the authors for this article.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rohan, K.J., Terman, J.M., Norton, R.J. et al. Antidepressant Medication Status as a Moderator of Winter Depression Recurrence Following Cognitive-Behavioral Therapy and Light Therapy: Is There Evidence of an Iatrogenic Effect?. Cogn Ther Res 47, 295–301 (2023). https://doi.org/10.1007/s10608-022-10344-7

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10608-022-10344-7

Keywords

Search

Navigation