title: Prevention of Relapse and Recurrence in Adults with Major Depressive Disorder: Systematic Review and Meta-Analyses of Controlled Trials.
abstract: BACKGROUND
  Findings of substantial remaining morbidity in treated major depressive disorder (MDD) led us to review controlled trials of treatments aimed at preventing early relapses or later recurrences in adults diagnosed with MDD to summarize available data and to guide further research.
  
  
  METHODS
  Reports (n = 97) were identified through systematic, computerized literature searching up to February 2015. Treatment versus control outcomes were summarized by random-effects meta-analyses.
  
  
  RESULTS
  In 45 reports of 72 trials (n = 14 450 subjects) lasting 33.4 weeks, antidepressants were more effective than placebos in preventing relapses (response rates [RR] = 1.90, confidence interval [CI]: 1.73-2.08; NNT = 4.4; p < 0.0001). In 35 reports of 37 trials (n = 7253) lasting 27.0 months, antidepressants were effective in preventing recurrences (RR = 2.03, CI 1.80-2.28; NNT = 3.8; p < 0.0001), with minor differences among drug types. In 17 reports of 22 trials (n = 1 969) lasting 23.7 months, psychosocial interventions yielded inconsistent or inconclusive results.
  
  
  CONCLUSIONS
  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 (pharmacological and psychological) conducted over longer times, as well as identifying clinical predictors of positive or unfavorable responses and of intolerability of long-term treatments in MDD.
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore (Drs K Sim, Lau, and J Sim); Research Department, Institute of Mental Health, Singapore (Dr K Sim and Ms Sum); Department of General Psychiatry, Institute of Mental Health, Singapore (Dr K Sim); Department of Psychiatry, Harvard Medical School, Boston, MA (Dr Baldessarini); International Consortium for Psychotic and Mood Disorders Research, McLean Hospital, Belmont, MA (Dr Baldessarini). kang_sim@imh.com.sg.
authors.forename: Kang
authors.initials: K
authors.lastname: Sim
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore (Drs K Sim, Lau, and J Sim); Research Department, Institute of Mental Health, Singapore (Dr K Sim and Ms Sum); Department of General Psychiatry, Institute of Mental Health, Singapore (Dr K Sim); Department of Psychiatry, Harvard Medical School, Boston, MA (Dr Baldessarini); International Consortium for Psychotic and Mood Disorders Research, McLean Hospital, Belmont, MA (Dr Baldessarini).
authors.forename: Wai Keat
authors.initials: WK
authors.lastname: Lau
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore (Drs K Sim, Lau, and J Sim); Research Department, Institute of Mental Health, Singapore (Dr K Sim and Ms Sum); Department of General Psychiatry, Institute of Mental Health, Singapore (Dr K Sim); Department of Psychiatry, Harvard Medical School, Boston, MA (Dr Baldessarini); International Consortium for Psychotic and Mood Disorders Research, McLean Hospital, Belmont, MA (Dr Baldessarini).
authors.forename: Jordan
authors.initials: J
authors.lastname: Sim
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore (Drs K Sim, Lau, and J Sim); Research Department, Institute of Mental Health, Singapore (Dr K Sim and Ms Sum); Department of General Psychiatry, Institute of Mental Health, Singapore (Dr K Sim); Department of Psychiatry, Harvard Medical School, Boston, MA (Dr Baldessarini); International Consortium for Psychotic and Mood Disorders Research, McLean Hospital, Belmont, MA (Dr Baldessarini).
authors.forename: Min Yi
authors.initials: MY
authors.lastname: Sum
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore (Drs K Sim, Lau, and J Sim); Research Department, Institute of Mental Health, Singapore (Dr K Sim and Ms Sum); Department of General Psychiatry, Institute of Mental Health, Singapore (Dr K Sim); Department of Psychiatry, Harvard Medical School, Boston, MA (Dr Baldessarini); International Consortium for Psychotic and Mood Disorders Research, McLean Hospital, Belmont, MA (Dr Baldessarini).
authors.forename: Ross J
authors.initials: RJ
authors.lastname: Baldessarini
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy / Q000379:methods; D018849:Controlled Clinical Trials as Topic / Q000379:methods*; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000517:prevention & control*; D006801:Humans; D011613:Psychotherapy / Q000379:methods; D012008:Recurrence; D055502:Secondary Prevention / Q000379:methods*
chemical_list: D000928:Antidepressive Agents
keywords: Antidepressants; depression; major depression; psychotherapy; recurrence; relapse