title: Three-Year long-term outcome of 458 naturalistically treated inpatients with major depressive episode: severe relapse rates and risk factors.
abstract: In randomized controlled trials, maintenance treatment for relapse prevention has been proven to be efficacious in patients responding in acute treatment, its efficacy in long-term outcome in "real-world patients" has yet to be proven. Three-year long-term data from a large naturalistic multisite follow-up were presented. Severe relapse was defined as suicide, severe suicide attempt, or rehospitalization. Next to relapse rates, possible risk factors including antidepressant medication were identified using univariate generalized log-rank tests and multivariate Cox proportional hazards model for time to severe relapse. Overall data of 458 patients were available for analysis. Of all patients, 155 (33.6%) experienced at least one severe relapse during the 3-year follow-up. The following variables were associated with a shorter time to a severe relapse in univariate and multivariate analyses: multiple hospitalizations, presence of avoidant personality disorder, continuing antipsychotic medication, and no further antidepressant treatment. In comparison with other studies, the observed rate of severe relapse during 3-year period is rather low. This is one of the first reports demonstrating a beneficial effect of long-term antidepressant medication on severe relapse rates in naturalistic patients. Concomitant antipsychotic medication may be a proxy marker for treatment resistant and psychotic depression.
authors.affiliation: Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Nussbaumstrasse 7, 80336, Munich, Germany, fseemuel@me.com.
authors.forename: Florian
authors.initials: F
authors.lastname: Seemüller
authors.forename: Sebastian
authors.initials: S
authors.lastname: Meier
authors.forename: Michael
authors.initials: M
authors.lastname: Obermeier
authors.forename: Richard
authors.initials: R
authors.lastname: Musil
authors.forename: Michael
authors.initials: M
authors.lastname: Bauer
authors.forename: Mazda
authors.initials: M
authors.lastname: Adli
authors.forename: Klaus
authors.initials: K
authors.lastname: Kronmüller
authors.forename: Florian
authors.initials: F
authors.lastname: Holsboer
authors.forename: Peter
authors.initials: P
authors.lastname: Brieger
authors.forename: Gerd
authors.initials: G
authors.lastname: Laux
authors.forename: Wolfram
authors.initials: W
authors.lastname: Bender
authors.forename: Isabella
authors.initials: I
authors.lastname: Heuser
authors.forename: Joachim
authors.initials: J
authors.lastname: Zeiler
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Gaebel
authors.forename: Michael
authors.initials: M
authors.lastname: Riedel
authors.forename: Peter
authors.initials: P
authors.lastname: Falkai
authors.forename: Hans-Jürgen
authors.initials: HJ
authors.lastname: Möller
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000453:epidemiology* / Q000523:psychology*; D005260:Female; D005858:Germany; D006801:Humans; D007297:Inpatients; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D016016:Proportional Hazards Models; D012008:Recurrence; D012307:Risk Factors; D059020:Suicidal Ideation; D013406:Suicide, Attempted; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents