Differing antidepressant maintenance methodologies

Research output: Contribution to journalReview articlepeer-review

Abstract

Background The principle evidence that antidepressant medication (ADM) is an effective maintenance treatment for adults with major depressive disorder (MDD) is from placebo substitution trials. These trials enter responders from ADM efficacy trials into randomized, double-blind placebo-controlled (RDBPC) effectiveness trials to measure the rate of MDD relapse over time. However, other randomized maintenance trial methodologies merit consideration and comparison. Methods A systematic review of ADM randomized maintenance trials included research reports from multiple databases. Relapse rate was the main effectiveness outcome assessed. Results Five ADM randomized maintenance methodologies for MDD responders are described and compared for outcome. These effectiveness trials include: placebo-substitution, ADM/placebo extension, ADM extension, ADM vs. psychotherapy, and treatment as usual. The placebo-substitution trials for those abruptly switched to placebo resulted in unusually high (46%) rates of relapse over 6–12 months, twice the continuing ADM rate. These trials were characterized by selective screening, high attrition, an anxious anticipation of a switch to placebo, and a risk of drug withdrawal symptoms. Selectively screened ADM efficacy responders who entered into 4–12 month extension trials experienced relapse rates averaging ~ 10% with a low attrition rate. Non-industry sponsored randomized trials of adults with multiple prior MDD episodes who were treated with ADM maintenance for 1–2 years experienced relapse rates averaging 40%. Conclusions Placebo substitution trial methodology represents only one approach to assess ADM maintenance. Antidepressant maintenance research for adults with MDD should be evaluated for industry sponsorship, attrition, the impact of the switch to placebo, and major relapse differences in MDD subpopulations.

Original languageEnglish (US)
Pages (from-to)87-95
Number of pages9
JournalContemporary Clinical Trials
Volume61
DOIs
StatePublished - Oct 1 2017

Keywords

  • Antidepressants
  • Effectiveness
  • Maintenance
  • Major depressive disorder
  • Placebo-substitution
  • Relapse rate
  • Treatment as usual

ASJC Scopus subject areas

  • Medicine(all)
  • Pharmacology (medical)

Fingerprint Dive into the research topics of 'Differing antidepressant maintenance methodologies'. Together they form a unique fingerprint.

Cite this