Meta-analysis of relapse prevention antidepressant trials in depressive disorders.
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).


METHODS
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.
Glue
Paul
P
Department of Psychological Medicine, University of Otago, Dunedin, New Zealand. paul.glue@otago.ac.nz
Donovan
Mary Rocco
MR
Kolluri
Sheela
S
Emir
Birol
B
D002986:Clinical Trials as Topic; D003866:Depressive Disorder / Q000188:drug therapy* / Q000517:prevention & control*; D006801:Humans; D016017:Odds Ratio; D055502:Secondary Prevention; D016896:Treatment Outcome