Discontinuation of antidepressants after remission with antidepressant medication in major depressive disorder: a systematic review and meta-analysis

被引：91

作者：

Kato, Masaki ^{[1
]}

Hori, Hikaru ^{[2
]}

Inoue, Takeshi ^{[3
]}

Iga, Junichi ^{[4
]}

Iwata, Masaaki ^{[5
]}

Inagaki, Takahiko ^{[6
,7
,8
]}

Shinohara, Kiyomi ^{[9
]}

Imai, Hissei ^{[9
]}

Murata, Atsunobu ^{[10
]}

Mishima, Kazuo ^{[11
]}

Tajika, Aran ^{[12
]}

机构：

[1] Kansai Med Univ, Dept Neuropsychiat, Osaka, Japan

[2] Univ Occupat & Environm Hlth, Dept Psychiat, Kitakyushu, Fukuoka, Japan

[3] Tokyo Med Univ, Dept Psychiat, Tokyo, Japan

[4] Ehime Univ, Dept Neuropsychiatry Mol & Funct, Grad Sch Med, Toon, Ehime, Japan

[5] Tottori Univ, Dept Neuropsychiat, Fac Med, Yonago, Tottori, Japan

[6] Biwako Hosp, Adolescent Mental Hlth Serv, Otsu, Shiga, Japan

[7] Shiga Univ Med Sci, Dept Psychiat, Otsu, Shiga, Japan

[8] Kyoto Univ, Dept Hlth Promot & Human Behav, Grad Sch Med, Kyoto, Japan

[9] Sch Publ Hlth, Kyoto, Japan

[10] Natl Ctr Neurol & Psychiat, Natl Inst Mental Hlth, Dept Pathol Mental Dis, Kodaira, Tokyo, Japan

[11] Akita Univ, Dept Neuropsychiat, Grad Sch Med, Akita, Japan

[12] Kyoto Univ Hosp, Dept Psychiat, Kyoto, Japan

来源：

MOLECULAR PSYCHIATRY | 2021年 / 26卷 / 01期

关键词：

LONG-TERM TREATMENT; DOUBLE-BLIND; RELAPSE PREVENTION; CONTINUATION TREATMENT; RECURRENT DEPRESSION; FLUOXETINE TREATMENT; DIAGNOSTIC-CRITERIA; COGNITIVE THERAPY; MAINTENANCE PHASE; PLACEBO;

D O I：

10.1038/s41380-020-0843-0

中图分类号：

Q5 [生物化学]; Q7 [分子生物学];

学科分类号：

071010 ; 081704 ;

摘要：

A significant clinical issue encountered after a successful acute major depressive disorder (MDD) treatment is the relapse of depressive symptoms. Although continuing maintenance therapy with antidepressants is generally recommended, there is no established protocol on whether or not it is necessary to prescribe the antidepressant used to achieve remission. In this meta-analysis, the risk of relapse and treatment failure when either continuing with the same drug used to achieved remission or switching to a placebo was assessed in several clinically significant subgroups. The pooled odds ratio (OR) (+/- 95% confidence intervals (CI)) was calculated using a random effects model. Across 40 studies (n = 8890), the relapse rate was significantly lower in the antidepressant group than the placebo group by about 20% (OR = 0.38, CI: 0.33-0.43,p < 0.00001; 20.9% vs 39.7%). The difference in the relapse rate between the antidepressant and placebo groups was greater for tricyclics (25.3%; OR = 0.30, CI: 0.17-0.50,p < 0.00001), SSRIs (21.8%; OR = 0.33, CI: 0.28-0.38,p < 0.00001), and other newer agents (16.0%; OR = 0.44, CI: 0.36-0.54,p < 0.00001) in that order, while the effect size of acceptability was greater for SSRIs than for other antidepressants. A flexible dose schedule (OR = 0.30, CI: 0.23-0.48,p < 0.00001) had a greater effect size than a fixed dose (OR = 0.41, CI: 0.36-0.48,p < 0.00001) in comparison to placebo. Even in studies assigned after continuous treatment for more than 6 months after remission, the continued use of antidepressants had a lower relapse rate than the use of a placebo (OR = 0.40, CI: 0.29-0.55,p < 0.00001; 20.2% vs 37.2%). The difference in relapse rate was similar from a maintenance period of 6 months (OR = 0.41, CI: 0.35-0.48,p < 0.00001; 19.6% vs 37.6%) to over 1 year (OR = 0.35, CI: 0.29-0.41,p < 0.00001; 19.9% vs 39.8%). The all-cause dropout of antidepressant and placebo groups was 43% and 58%, respectively, (OR = 0.47, CI: 0.40-0.55,p < 0.00001). The tolerability rate was similar to 4% for both groups. The rate of relapse (OR = 0.32, CI: 0.18-0.64,p = 0.0010, 41.0% vs 66.7%) and all-cause dropout among adolescents was higher than in adults. To prevent relapse and treatment failure, maintenance therapy, and careful attention for at least 6 months after remission is recommended. SSRIs are well-balanced agents, and flexible dose adjustments are more effective for relapse prevention.

引用

页码：118 / 133

页数：16

共 63 条

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