Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2015 Jul 7;19(2):pyv076.
doi: 10.1093/ijnp/pyv076.

Prevention of Relapse and Recurrence in Adults with Major Depressive Disorder: Systematic Review and Meta-Analyses of Controlled Trials

Kang Sim  1 , Wai Keat Lau  2 , Jordan Sim  2 , Min Yi Sum  2 , Ross J Baldessarini  2
Affiliations
Meta-Analysis

Prevention of Relapse and Recurrence in Adults with Major Depressive Disorder: Systematic Review and Meta-Analyses of Controlled Trials

Kang Sim et al. Int J Neuropsychopharmacol. .

Erratum in

  • Erratum.
    [No authors listed] [No authors listed] Int J Neuropsychopharmacol. 2016 Apr 27;19(10):pyw031. doi: 10.1093/ijnp/pyw031. Int J Neuropsychopharmacol. 2016. PMID: 27207904 Free PMC article. No abstract available.

Abstract

Background: Findings of substantial remaining morbidity in treated major depressive disorder (MDD) led us to review controlled trials of treatments aimed at preventing early relapses or later recurrences in adults diagnosed with MDD to summarize available data and to guide further research.

Methods: Reports (n = 97) were identified through systematic, computerized literature searching up to February 2015. Treatment versus control outcomes were summarized by random-effects meta-analyses.

Results: In 45 reports of 72 trials (n = 14 450 subjects) lasting 33.4 weeks, antidepressants were more effective than placebos in preventing relapses (response rates [RR] = 1.90, confidence interval [CI]: 1.73-2.08; NNT = 4.4; p < 0.0001). In 35 reports of 37 trials (n = 7253) lasting 27.0 months, antidepressants were effective in preventing recurrences (RR = 2.03, CI 1.80-2.28; NNT = 3.8; p < 0.0001), with minor differences among drug types. In 17 reports of 22 trials (n = 1 969) lasting 23.7 months, psychosocial interventions yielded inconsistent or inconclusive results.

Conclusions: Despite evidence of the efficacy of drug treatment compared to placebos or other controls, the findings further underscore the substantial, unresolved morbidity in treated MDD patients and strongly encourage further evaluations of specific, improved individual and combination therapies (pharmacological and psychological) conducted over longer times, as well as identifying clinical predictors of positive or unfavorable responses and of intolerability of long-term treatments in MDD.

Keywords: Antidepressants; depression; major depression; psychotherapy; recurrence; relapse.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Flow chart of study selection process: 803 reports screened, 146 reviewed in detail, and 97 included for analysis, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations (http://www.prisma-statement.org/statement.htm).
Figure 2.
Figure 2.
Findings from random-effects meta-analysis of 37 controlled, long-term trials (>12 months) of antidepressants vs. placebos in major depression. The pooled ratio (RR) of recurrence risk with placebo vs. antidepressants, of 2.03 [CI: 1.80-2.28]) is highly significant (z-score = 11.7, p < 0.0001).
See this image and copyright information in PMC

References

    1. Alexopoulos GS, Meyers BS, Young RC, Kalayam B, Kakuma T, Gabrielle M, Sirey JA, Hull J. (2000) Executive dysfunction and long-term outcomes of geriatric depression. Arch Gen Psychiatry 57:285–290. - PubMed
    1. Amsterdam JD, Bodkin JA. (2006) Selegiline transdermal system in the prevention of relapse of major depressive disorder: 52-week, double-blind, placebo-substitution, parallel-group clinical trial. J Clin Psychopharmacol 26:579–586. - PubMed
    1. Baldessarini RJ. (2013) Chemotherapy in Psychiatry, 3rd edition. New York: Springer Press.
    1. Baldessarini RJ, Tondo L, Ghiani C, Lepri B. (2010) Illness risk following rapid versus gradual discontinuation of antidepressants. Am J Psych 167:934–941. - PubMed
    1. Baldessarini RJ, Lau WK, Sim J, Sum MY, Sim K. (2015) Duration of initial antidepressant treatment and subsequent relapse of major depression. J Clin Psychopharmacol 35:75–76. - PubMed

Publication types

MeSH terms

Substances