Maintenance therapy to prevent recurrence of depression: summary and implications of the PREVENT study

Abstract

The need for maintenance therapy in patients with major depressive disorder (MDD) is underscored by the high likelihood of recurrence after short-term treatment. Current recommendations include treatment to remission and long-term treatment to prevent relapse and recurrence. This article will summarize the design and results of the Prevention of Recurrent Episodes of Depression with Venlafaxine for Two Years (PREVENT) study, which have been published elsewhere. PREVENT evaluated venlafaxine extended release (ER) versus placebo in two 1-year maintenance phases for prevention of recurrence in patients with MDD who responded to acute and continuation therapy. Venlafaxine ER was effective in preventing long-term recurrence when compared with placebo, with a significant reduction in likelihood of recurrence and significantly longer time to recurrence after both 1 and 2 years of maintenance therapy. Recurrence rates in the first and second maintenance periods for patients receiving placebo were similar (42 vs 45%), but recurrence rates for patients receiving venlafaxine ER decreased dramatically (23 vs 8%). The PREVENT study adds to current understanding regarding the benefits of long-term antidepressant therapy in preventing recurrence.

Antidepressive Effect of Mirtazapine in Post-Myocardial Infarction Depression Is Associated with Soluble TNF-R1 Increase: Data from the MIND-IT

“…a Standardized regression coefficient of the association between treatment and residualized change scores of immune parameters. These findings suggest that placebo and mirtazapine cause remission of post-MI depression through different mechanisms, which is in accordance with the results of ADT continuation studies that demonstrate that relapse rates are much higher for placebo compared to ADT [32,33] . Although statistically highly significant, the association between therapeutic efficacy of mirtazapine and inflammation parameters was limited to an increase in sTNF-R1 only.…”

“…Higher serum levels of TNF-␣ predict nonresponse to ADT with selective serotonin reuptake inhibitors [11] and relapse of depressive disorder after remission [35,39] . Successful ADT is associated with (1) changes in the interaction between TNF-␣ and the hypothalamic-pituitary-adrenal axis and (2) TNF-␣ -modulated functioning of the noradrenergic ␣ receptor [33,40] .…”

Structural and functional alterations to rat medial prefrontal cortex following chronic restraint stress and recovery

“…Whether these structural differences result in increased susceptibility to, or enhanced protection from, future stressors is unknown. Nevertheless, there is an almost 50% chance of mood disorder relapse following disease remission (Bockting et al, 2008, Kornstein, 2008). We believe that a comprehensive analysis of both rest-promoted dendritic extension as well as the stress susceptibility of extended neurons are critical next steps in understanding the cellular underpinnings of mood disorder relapse and recovery.…”

Predictive Value of Family History on Severity of Illness

“…Thus, family history may identify a subgroup in need of primary or early intervention, and for whom treatments appropriate for recurrent, highly disabling disorder may be needed. 111 Second, selecting early-onset cases (ie, those whose onset is in their teens or 20s) may not necessarily result in the selection of homogeneous cases with a more familial or genetic form of disorder. Researchers may be better off selecting cases with recurrent disorder or those with high impairment of function or, better still, collecting family history information directly.…”