Strategies for antidepressant medications in the maintenance phase: A systematic review and network Meta-analysis

In the management of depression, achieving and maintaining remission is crucial. This study aims to compare and rank the effectiveness of several antidepressant medication strategies for patients with depression in the maintenance phase.

We included randomized controlled trials (RCTs) by searching MEDLINE, EMBASE, PsycINFO, CENTRAL, CINAHL, PubMed and Web of Science. We included studies comparing at least two of the five treatment strategies: continuing the current antidepressant at the same dose; reducing the antidepressant dose; increasing the antidepressant dose; switching to another antidepressant; stopping and replacing the antidepressant with placebo. A standard random-effects network meta-analysis (NMA) was used to synthesize data. The study protocol was registered with PROSPERO, number CRD42023417283.

A total of 24 studies with 6055 individuals were included for analysis. All strategies outperformed stopping medication in relapse prevention. Specifically, continuing the same dose (RR 0.54; 95 % CI, 0.48-0.60), reducing dose (RR 0.49; 95 % CI, 0.34-0.72), increasing dose (RR 0.53; 95 % CI, 0.34-0.82), and switching to another antidepressant (RR 0.64; 95 % CI, 0.48-0.84) demonstrated significant efficacy.

These results suggest that continuing and reducing dose may show good performance in terms of efficacy, tolerability, and acceptability for patients with depression in the maintenance phase. Increased dose doesn't reduce efficacy but patients are more likely to interrupt treatment. Switching has moderate efficacy and acceptability, but the risk of adverse events is higher. Due to the limited number of included studies, further research is needed to determine these results.