Postpartum depression recurrence versus discontinuation syndrome: observations from a randomized controlled trial.
OBJECTIVE
To differentiate characteristics of a discontinuation syndrome from a recurrence of major depressive disorder in the context of a randomized trial.


METHODS
We performed a randomized clinical trial to compare the efficacy of sertraline versus placebo for the prevention of recurrent postpartum DSM-IV major depressive disorder. Women whose depression did not recur in the initial 17-week active treatment trial were followed through the taper phase (weeks 18-20). At week 17, 3 women assigned to placebo and 8 assigned to sertraline remained in the trial. Nine symptoms that characterize discontinuation syndrome were extracted from the 25-item Asberg Rating Scale for Side Effects (ASE) and assessed weekly during the taper phase. The 21-item Hamilton Rating Scale for Depression was used to evaluate depressive symptoms.


RESULTS
In the taper phase, there were no significant differences between the sertraline- and placebo-treated women on the sum of the ASE-derived symptoms. Both groups had low levels of symptoms on the ASE during the weeks of taper. None of the 3 women assigned to placebo and 2 of the 8 women assigned to sertraline suffered a depressive recurrence within 6 weeks of the end of the study.


CONCLUSIONS
A gradual taper of sertraline (75 mg) over 3 weeks did not lead to discontinuation syndrome; however, the systematic dissection of symptoms resulted in our conclusion that the duration of preventive therapy should be extended to 26 weeks (about 6 months) in subsequent randomized trials, consistent with the treatment guidelines for a single episode of depression.
Sunder
Keerthy R
KR
Department of Psychiatry, and Women's Behavioral HealthCARE, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
Wisner
Katherine L
KL
Hanusa
Barbara H
BH
Perel
James M
JM
D000328:Adult; D019052:Depression, Postpartum / Q000175:diagnosis* / Q000188:drug therapy / Q000517:prevention & control*; D003937:Diagnosis, Differential; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D010919:Placebos; D011569:Psychiatric Status Rating Scales; D055502:Secondary Prevention; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D020280:Sertraline / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis* / Q000209:etiology; D013997:Time Factors
D010919:Placebos; D017367:Selective Serotonin Reuptake Inhibitors; D020280:Sertraline