Antidepressant dose reduction and the risk of relapse in major depressive disorder

Whether the dose of antidepressants can be reduced following clinical improvement without subsequently increasing the likelihood of depressive relapse has not been established. Thus, the aim of this work was to compare relapse rates among patients with major depressive disorder (MDD) randomized to either continue receiving the full versus a reduced dose of antidepressants following partial or full improvement of symptoms.

Five double-blind, randomized clinical trials involving 1,009 patients with MDD randomized to either continue receiving the full versus a reduced dose of antidepressants following partial or full improvement of symptoms were pooled using a random-effect meta-analysis model.

Patients randomized to continue treatment with lower doses of antidepressants were more likely to experience a depressive relapse than patients who continued treatment with the full dose (risk ratio 1.62, 95% confidence interval: 1.52-2.80, p = 0.001). Pooled relapse rates were 25.3 and 15.1% for the two treatment groups.

Decreasing the antidepressant dose following partial or full symptom improvement is associated with an increased risk of relapse in MDD.