Some individuals with a history of depression may sink back into thinking patterns associated with the condition when faced with mild stresses or sadness, increasing their risk for relapse, according to a report in the July issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

Many patients who recover from depression eventually relapse, according to background information in the article. Management of depression usually focuses on alleviating symptoms rather than reducing the risk for recurrence or identifying patients who might relapse after successful treatment. Previous studies have found that some patients who have recovered from depression still show cognitive processes--patterns in thinking, learning and memory--commonly associated with the condition, while others in remission do not. Such cognitive processes include certain ways of explaining events or particular assumptions about self-worth.

Zindel V. Segal, Ph.D., University of Toronto and Centre for Addiction and Mental Health, Ontario, and colleagues randomly assigned 301 patients with major depressive disorder to receive either antidepressant medications or cognitive behavioral therapy (a kind of psychotherapy designed to modify the cognitive processes that are typically associated with depression). Ninety-nine of those whose depression went into remission participated in a second phase of the trial. These 99 participants rated their current mood on a visual scale from sad to happy and underwent an assessment of their dysfunctional attitudes, signs of the cognitive processes that are associated with depression. The researchers then provoked a sad mood by asking participants to listen to a piece of music and try to recall a time in their lives when they felt sad. After this exercise, the participants rated their mood and underwent the dysfunctional attitude assessment a second time and were observed bimonthly for the next 18 months.