Meta-analysis of Major Depressive Disorder Relapse and Recurrence With Second-Generation Antidepressants

Abstract

Objective-To review data on the efficacy and effectiveness of second-generation antidepressants for preventing major depression relapse and recurrence during continuation and maintenance phase treatment, respectively.Methods-MEDLINE®, EMBASE, and PsychLit; the Cochrane Library; and the International Pharmaceutical Abstracts were searched from January 1980 through April 2007 for reviews, randomized controlled trials, meta-analyses, and observational studies. Two persons independently reviewed abstracts and full text articles using a structured data abstraction form to ensure consistency in appraisal and data extraction.Findings-Four comparative trials and 23 placebo controlled trials that addressed relapse or recurrence prevention were included. Results of comparative trials have not demonstrated statistically significant differences between duloxetine and paroxetine, fluoxetine and sertraline, fluvoxamine and sertraline, and trazodone and venlafaxine. Pooled data for the class of secondgeneration antidepressants compared with placebo suggest a relatively large effect size that persists over time. The number needed to treat to prevent one additional relapse or recurrence is 5 (95% CI 4 to 6). Differences in the length of open-label treatment prior to randomization, drug type, and trial duration did not affect pooled estimates of relapse rates (P = 0.716, P = 0.507, and P = 0.480, aCorresponding author and reprint address:

A lifetime approach to major depressive disorder: The contributions of psychological interventions in preventing relapse and recurrence

“…Not surprisingly, the modal strategy to prevent relapse after remission is continuation ADM (Geddes et al, 2003;Glue, Donovan, Kolluri, & Emir, 2010;Hansen et al, 2008;Kaymaz, van Os, Loonen, & Nolen, 2008). However, there is also evidence that indicates that the effects of antidepressants are smaller than presumed (Gøtzsche, 2014) and have harmful effects for elderly (Coupland et al, 2011).…”

“…There is no evidence that ADMs reduce subsequent risk when discontinued; and indeed symptoms frequently re-emerge when ADMs are discontinued (Geddes et al, 2003;Glue et al, 2010;Guidi, Fava, Fava, & Papakostas, 2011;Hansen et al, 2008;Imel, Malterer, McKay, & Wampold, 2008;Kaymaz et al, 2008;Oestergaard & Møldrup, 2011;Pigott, Leventhal, Alter, & Boren, 2010;Vittengl, Clark, Dunn, & Jarrett, 2007). Adverse effects of use of antidepressants have been reported as well, especially based on observational (clinical) studies (Fava, 2014;Gøtzsche, 2014).…”

Network Meta-Analysis and Cost-Effectiveness Analysis of New Generation Antidepressants

“…The doses of three augmentation drugs and associated remission rates were obtained from the Sequenced Treatment Alternatives to Relieve Depression study [21] and a study conducted in Asia [22] ( Table 1). The risk of relapse after remission was 7.7 % [23] and was assumed to be similar irrespective of initial treatment [24].…”

Effectiveness of Supported Self-Help in Recurrent Depression: A Randomized Controlled Trial in Primary Care

“…Current guidelines recommend continuation of antidepressant medication (ADM) and/or psychological treatment, e.g., cognitive (behavioral) therapy (CT or CBT), to reduce the risk of relapse and recurrence [7,8]. The most commonly used strategy is a continuation of ADM [9,10,11,12]. The recommendations on ADM are under debate [12] as the optimal duration of the continuation or maintenance phase has not been studied well enough [9,11].…”