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Review: maintenance antidepressants reduce risk of relapse but effect is not as great in recurrent depression

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QUESTION

Question:

Does the risk of relapse/recurrence of major depression following antidepressant treatment post-remission depend upon the duration of continuation/maintenance treatment, the number of previous depressive episodes or the mode of discontinuation of treatment?

Outcomes:

Relapse (within 6 months of remission) and recurrence (after 6 months of remission).

METHODS

Design:

Systematic review with meta-regression analysis.

Data sources:

MEDLINE, EMBASE and the Cochrane Library were searched for randomised, placebo controlled trials (RCTs) published up to May 2007. Obtained articles were hand searched for further references. Authors were contacted if required information was not available in the article.

Study selection and analysis:

The reviewers included double blind RCTs in participants with major depressive disorder treated with a selective serotonin reuptake inhibitor (SSRI) or tricyclic antidepressant (TCA) until remission, after which they had to be randomised to either the same antidepressant or placebo for continuation/maintenance therapy. Two reviewers assessed the studies. Data were analysed using random effects model meta-regression procedures. Heterogeneity between studies was assessed with χ2 tests. Publication bias was assessed using the funnel plot.

MAIN RESULTS

Forty-four RCTs were identified as possibly suitable for inclusion and …

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