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Antidepressant Maintenance Versus Active Monitoring After Depression Remission: A Decision Analysis Stratified by
William U Meyerson1,2, Tianxi Cai3,4, Jordan W Smoller1,2,5
1Center for Precision Psychiatry, Massachusetts General Hospital, Boston, Massachusetts.
Medrxiv : the Preprint Server for Health Sciences
|August 1, 2026
Summary
Choosing between continuing antidepressant medication or stopping it after major depressive disorder (MDD) remission depends on relapse risk and patient preferences. Continuous maintenance reduces depression burden but increases medication exposure, especially for low-risk patients.
Area of Science:
- Clinical Psychiatry
- Health Decision Science
- Pharmacoeconomics
Background:
- Major depressive disorder (MDD) remission presents a critical decision point for patients regarding ongoing antidepressant maintenance versus discontinuation with active monitoring.
- Quantifying the trade-offs between depression burden and long-term medication exposure is crucial for personalized shared decision-making.
Purpose of the Study:
- To quantify the trade-offs between continuous antidepressant maintenance and active monitoring strategies following MDD remission.
- To identify patient preference thresholds that favor each strategy across different relapse-risk strata.
Main Methods:
- An individual-level decision-analytic health-state transition model was developed.
- The model was calibrated using data from randomized maintenance-discontinuation trials and a longitudinal cohort of first depressive episodes.
- A 5-year time horizon was employed for the analysis.
Main Results:
- Continuous antidepressant maintenance reduced depression burden but necessitated significantly higher medication exposure.
- The efficiency of maintenance therapy, measured as medication-years per depression-month averted, varied substantially by relapse risk, ranging from 11.8 in very low-risk groups to 1.5 in high-risk groups.
- Maintenance was favored for moderate-to-high-risk patients at a preference threshold of 3 medication-years per depression-month averted, and only for high-risk patients at a threshold of 2.
Conclusions:
- The decision to continue antidepressant maintenance post-MDD remission is strongly influenced by individual relapse risk and patient preferences regarding long-term medication exposure.
- The study provides a quantitative framework to support shared decision-making processes for antidepressant maintenance strategies.
- Personalized treatment decisions can optimize the balance between managing depression recurrence and minimizing medication-related burdens.
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