Meta-Analysis of Relapse Prevention Antidepressant Trials in Depressive Disorders
- 1 August 2010
- journal article
- research article
- Published by SAGE Publications in Australian & New Zealand Journal of Psychiatry
- Vol. 44 (8), 697-705
- https://doi.org/10.3109/00048671003705441
Abstract
Objective: Continuation therapy with antidepressants is recommended for depressed patients who have responded to initial treatment. We quantified its efficacy in preventing relapse of depression in a meta-analysis of 54 double-blind placebo-controlled relapse prevention studies (patient n = 9268). Method: Relapse prevention studies in primary depression and depression subtypes were identified in a systematic literature search. The primary efficacy comparison was relapse rates between active and placebo arms calculated as odds ratios (ORs) using Review Manager version 5.0. Effects of patient age, drug class, diagnostic system and duration of therapy on ORs was examined, along with ORs calculated using different statistical methods. Results: Continuation antidepressants produced robust reduction in relapse (OR = 0.35; 95%CI 0.32–0.39). Pooled ORs were not affected by patient age, drug class, depression subtype or treatment duration, and were similar when calculated by different statistical methods. Patients with primary depression diagnosed by earlier diagnostic systems had slightly lower ORs than those diagnosed using DSM criteria. Conclusions: This meta-analysis emphasizes the importance of continuation treatment following acute response in depressive disorders. The robust findings of relapse prevention designs contrast with acute antidepressant efficacy studies, and may be due to enrichment of the patient population.Keywords
This publication has 63 references indexed in Scilit:
- Evidence That Patients With Single Versus Recurrent Depressive Episodes Are Differentially Sensitive to Treatment DiscontinuationThe Journal of Clinical Psychiatry, 2008
- Evidence-based guidelines for treating depressive disorders with antidepressants: A revision of the 2000 British Association for Psychopharmacology guidelinesJournal of Psychopharmacology, 2008
- Metareview on Short-Term Effectiveness and Safety of Antidepressants for Depression: An Evidence-Based Approach to Inform Clinical PracticeThe Canadian Journal of Psychiatry, 2007
- Global burden of depressive disorders in the year 2000The British Journal of Psychiatry, 2004
- Relapse prevention with antidepressant drug treatment in depressive disorders: a systematic reviewThe Lancet, 2003
- Frequency of Positive Studies Among Fixed and Flexible Dose Antidepressant Clinical Trials: An Analysis of the Food and Drug Administraton Summary Basis of Approval ReportsNeuropsychopharmacology, 2002
- Weekly Dosing of Fluoxetine for the Continuation Phase of Treatment of Major Depression: Results of a Placebo-Controlled, Randomized Clinical TrialJournal of Clinical Psychopharmacology, 2000
- Executive Dysfunction and Long-term Outcomes of Geriatric DepressionArchives of General Psychiatry, 2000
- The Effects of Adherence to Antidepressant Treatment Guidelines on Relapse and Recurrence of DepressionArchives of General Psychiatry, 1998
- Meta-analysis in clinical trialsControlled Clinical Trials, 1986