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Differing antidepressant maintenance methodologies.

Daniel J Safer1

  • 1Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States.

Contemporary Clinical Trials
|July 26, 2017
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Summary
This summary is machine-generated.

Placebo substitution trials show high relapse rates for major depressive disorder (MDD) maintenance treatment. Alternative methods like ADM extension trials offer lower relapse rates for adults with MDD.

Keywords:
AntidepressantsEffectivenessMaintenanceMajor depressive disorderPlacebo-substitutionRelapse rateTreatment as usual

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Area of Science:

  • Psychiatry
  • Clinical Psychology
  • Pharmacology

Background:

  • Antidepressant medication (ADM) is a primary maintenance treatment for major depressive disorder (MDD).
  • Evidence for ADM effectiveness primarily stems from placebo substitution trials.
  • Alternative randomized maintenance trial methodologies warrant investigation and comparison.

Purpose of the Study:

  • To systematically review and compare different randomized maintenance trial methodologies for adults with MDD.
  • To assess the effectiveness of various ADM maintenance strategies.
  • To identify factors influencing relapse rates in MDD maintenance treatment.

Main Methods:

  • A systematic review of randomized ADM maintenance trials was conducted.
  • Research reports were gathered from multiple electronic databases.
  • Relapse rate was the primary outcome measure for treatment effectiveness.

Main Results:

  • Five distinct ADM maintenance methodologies were identified and compared: placebo-substitution, ADM/placebo extension, ADM extension, ADM vs. psychotherapy, and treatment as usual.
  • Placebo-substitution trials showed high relapse rates (46%) compared to continuing ADM.
  • ADM extension trials with selectively screened responders had lower relapse rates (~10%).
  • Non-industry sponsored trials in adults with recurrent MDD showed higher relapse rates (40%) with ADM maintenance.

Conclusions:

  • Placebo substitution is only one method for evaluating ADM maintenance; other methodologies exist.
  • Future research on ADM maintenance for MDD should consider industry sponsorship, attrition rates, and the impact of placebo switching.
  • Relapse differences across MDD subpopulations require further investigation.