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Letters to the Editor |

The Role of Residual Subthreshold Depressive Symptoms in Early Episode Relapse in Unipolar Major Depressive Disorder—Reply

Giovanni A. Fava, MD; Chiara Rafanelli, MD, PhD; Silvana Grandi, MD; Sandra Conti, MD; Piera Belluardo, PhD
Arch Gen Psychiatry. 1999;56(8):764-765. doi:.
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In our article,1 we indicated how CBT induced significant improvement in residual symptoms, unlike CM. We may provide a closer look at what happened by classifying patients according to the presence of at least one residual symptom with a score of 3 or more in the Clinical Interview for Depression,2 as was done in previous research.3 At enrollment in the study, no patients in the CBT and 2 of the 20 in the CM group had no residual symptoms. As a result, fully asymptomatic status was achieved by only 5% of the sample. This percentage was found to be only slightly higher in nonrecurrent, successfully treated, MDD.3,4 After CBT, 12 of the 20 patients became fully asymptomatic. They had a significantly longer survival time (mean=101.2 weeks; SD=9.8 weeks) compared with the 8 patients who still had residual symptoms (mean=72.7 weeks; SD=28.9 weeks) by survival analysis (log-rank test, χ21=4.82; P <.05). There were 2 cases of fully asymptomatic status on retest in the CM group. When the patients were divided according to the presence of residual symptoms regardless of treatment assignment, the differences became striking (log-rank test, χ21=11.28; P <.001). The 14 patients without residual symptoms had a significantly longer survival time (mean=98.4 weeks; SD=14.3 weeks) compared with the 26 with residual symptoms (mean=65.4 weeks; SD=27.7 weeks).

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