Relapse prevention with antidepressant drug treatment in depressive disorders: a systematic review

@article{Geddes2003RelapsePW,
  title={Relapse prevention with antidepressant drug treatment in depressive disorders: a systematic review},
  author={John R. Geddes and Stuart Carney and Christina Davies and Toshiaki Furukawa and David J. Kupfer and Ellen Frank and Guy M. Goodwin},
  journal={The Lancet},
  year={2003},
  volume={361},
  pages={653-661}
}

Figures from this paper

Meta-Analysis of Relapse Prevention Antidepressant Trials in Depressive Disorders
TLDR
This meta-analysis emphasizes the importance of continuation treatment following acute response in depressive disorders, and the robust findings of relapse prevention designs contrast with acute antidepressant efficacy studies, and may be due to enrichment of the patient population.
Evidence that patients with single versus recurrent depressive episodes are differentially sensitive to treatment discontinuation: a meta-analysis of placebo-controlled randomized trials.
TLDR
There is evidence, however, that with increasing number of episodes, patients develop a relative resistance against the prophylactic properties of antidepressant medication, regardless of a number of clinical and pharmacologic factors.
Antidepressant medication to prevent depression relapse in primary care: the ANTLER RCT.
TLDR
This trial investigated the clinical effectiveness and cost-effectiveness of antidepressant medication in preventing relapse in UK primary care and revealed that people who discontinue long-term maintenance antidepressants in primary care are at increased risk of relapse and withdrawal symptoms.
Long-Term Treatment of Depression with Antidepressants: A Systematic Narrative Review
Objective: To examine the available scientific evidence for answers to clinically relevant questions on the effectiveness and tolerability of antidepressant drugs (ADs) for the long-term treatment of
Antidepressants for bipolar depression: a systematic review of randomized, controlled trials.
TLDR
The trial data do not suggest that switching is a common early complication of treatment with antidepressants, and it may be prudent to use a selective serotonin reuptake inhibitor or a monoamine oxidase inhibitor rather than a tricyclic antidepressant as first-line treatment.
Prevention of Relapse and Recurrence in Adults with Major Depressive Disorder: Systematic Review and Meta-Analyses of Controlled Trials
TLDR
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 conducted over longer times.
Antidepressant Dose Reduction and the Risk of Relapse in Major Depressive Disorder
TLDR
Cutting the antidepressant dose following partial or full symptom improvement is associated with an increased risk of relapse in MDD.
Interventions for preventing relapse and recurrence of a depressive disorder in children and adolescents.
TLDR
There is little evidence to conclude which type of treatment approach is most effective in preventing relapse or recurrence of depressive episodes in children and adolescents, and the designs implemented in trials was diverse, which limits the generalisability of the results.
Continuation and maintenance treatments for depression in older people.
TLDR
The long-term benefits of continuing antidepressant medication in the prevention of recurrence of depression in older people are not clear and no firm treatment recommendations can be made on the basis of this review.
...
...

References

SHOWING 1-10 OF 58 REFERENCES
Maintenance therapy for chronic depression. A controlled clinical trial of desipramine.
TLDR
Long-term maintenance treatment with desipramine appeared to be effective in the prevention or postponement of relapse of depression in patients who responded to desipramsine during the acute and continuation phases.
Maintenance phase efficacy of sertraline for chronic depression: a randomized controlled trial.
TLDR
Maintenance therapy with sertraline is well tolerated and has significant efficacy in preventing recurrence or reemergence of depression in chronically depressed patients.
Citalopram in doses of 20–60 mg is effective in depression relapse prevention: a placebo‐controlled 6 month study
TLDR
The hypothesis that full dose continuation treatment is more effective than placebo in preventing relapse of depression is supported, and is in general agreement with those of other studies on antidepressants.
Prophylactic effect of citalopram in unipolar, recurrent depression: placebo-controlled study of maintenance therapy.
TLDR
Citalopram (20, 40 and 60 mg) is effective in the prevention of depressive recurrences and patients at risk should continue maintenance treatment at the dose necessary to resolve symptoms in the acute treatment phase.
Nortriptyline and interpersonal psychotherapy as maintenance therapies for recurrent major depression: a randomized controlled trial in patients older than 59 years.
TLDR
In geriatric patients with recurrent major depression, maintenance treatment with nortriptyline or IPT is superior to placebo in preventing or delaying recurrence and combined treatment using both appears to be the optimal clinical strategy in preserving recovery.
Paroxetine is better than placebo in relapse prevention and the prophylaxis of recurrent depression
TLDR
Paroxetine was effective in preventing the reappearance of depression following an acute illness and the benefit of long-term pharmacotherapy for treating depressive illness is confirmed.
Five-year outcome for maintenance therapies in recurrent depression.
TLDR
It is concluded that active imipramine treatment is an effective means of preventing recurrence beyond 3 years and that patients with previous episodes less than 2 1/2 years apart, therefore, merit continued prophylaxis for at least 5 years.
Efficacy of Citalopram in the prevention of recurrent depression in elderly patients: Placebo-controlled study of maintenance therapy
TLDR
Long-term treatment with citalopram is effective in preventing recurrence of depression in the elderly and is well tolerated.
Double-blind, placebo-substitution study of nefazodone in the prevention of relapse during continuation treatment of outpatients with major depression.
TLDR
The clinical effectiveness of up to 1 year's treatment with nefazodone in depressed patients was demonstrated, accompanied by a good safety profile without any weight gain and with minimal symptoms of withdrawal upon abrupt discontinuation of treatment.
Three-year outcomes for maintenance therapies in recurrent depression.
TLDR
It is concluded that active imipramine hydrochloride maintained at an average dose of 200 mg is an effective means of preventing recurrence and that monthly interpersonal psychotherapy serves to lengthen the time between episodes in patients not receiving active medication.
...
...