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Risk of Recurrence of Depression During Long-Term Antidepressant Treatment

Published online by Cambridge University Press:  07 November 2014

Diane M. Sloan  and
Susan G. Kornstein
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Extract

Major depressive disorder (MDD) is widespread, costly, and frequently chronic. Internationally, the burden of depression is large and growing. By the year 2020, this disorder is projected to be the world's second leading cause of disease burden. The costs associated with depression are enormous; people with depression tend to have approximately double the health care costs of unaffected individuals. There are few other major disorders that have a negative health impact of the same magnitude.

Early onset of depressive symptoms, along with underdiagnosis and undertreatment, contribute to the burden of MDD, which is also characterized by chronicity, frequent relapses, and recurrences. Risk factors for depressive recurrence include the presence of residual symptoms, >3 prior depressive episodes, chronic depression lasting more than 2 years, a family history of mood disorders, other comorbidities (eg, terminal illness, diabetes), and late onset (>60 years of age). Patients who have any of these factors should be candidates for maintenance treatment.

Naturalistic studies have demonstrated that most patients with MDD without sustained treatment will eventually experience a relapse or recurrence. Furthermore, depressive episodes tend to become more autonomous over time, with decreased linkage to stressful life events, more severe, and potentially more refractory with each new relapse or recurrence. Researchers and clinicians have observed that rather than only treat or manage relapses or recurrences of MDD, the best strategy may be prevention of depressive episodes. As a result, current strategies seek to treat patients to remission, which translates to a lower overall risk of developing relapses or recurrences compared with those patients who continue to demonstrate residual symptoms. Thus, a consistent body of evidence now supports continuous pharmacotherapy for the prevention of depressive relapse and recurrence.

Type
Research Article
Information
CNS Spectrums , Volume 12 , Issue S19 , November 2007 , pp. 1 - 7
Copyright
Copyright © Cambridge University Press 2007

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References

1.World Health Organization. The World Health Report: 2001—Mental Health: New Understanding, New Hope. Geneva, Switzerland: World Health Organization; 2001.Google Scholar
2.Luppa, M, Heinrich, S, Angermeyer, MC, Konig, HH, SG, Riedel-Heller. Cost-of-illness studies of depression: a systematic review. J Affect Disord. 2007;98(1-2):29–43.CrossRefGoogle ScholarPubMed
3.Greenberg, PE, Birnbaum, HG. The economic burden of depression in the US: societal and patient perspectives. Expert Opin Pharmacother. 2005;6(3):369–376.CrossRefGoogle ScholarPubMed
4.Simon, GE, VonKorff, M, Barlow, W. Health care costs of primary care patients with recognized depression. Arch Gen Psychiatry. 1995;52(10):850–856.CrossRefGoogle ScholarPubMed
5.Moussavi, S, Chatterji, S, Verdes, E, Tandon, A, Patel, V, Ustun, B. Depression, chronic diseases, and decrements in health: results from the World Health Surveys. Lancet. 2007;370(9590):851–858.CrossRefGoogle ScholarPubMed
6.Hollon, SD, Shelton, RC, Wisniewski, S, et al.Presenting characteristics of depressed outpatients as a function of recurrence: Preliminary findings from the STAR*D clinical trial. J Psychiatr Res. 2006;40(1):59–69.CrossRefGoogle ScholarPubMed
7.Keller, MB, Boland, RJ. Implications of failing to achieve successful long-term maintenance treatment of recurrent unipolar major depression. Biol Psychiatry. 1998;44(5):348–360.CrossRefGoogle ScholarPubMed
8.Mueller, TI, Leon, AC, Keller, MB, et al.Recurrence after recovery from major depressive disorder during 15 years of observational follow-up. Am J Psychiatry. 1999;156(7):1000–1006.CrossRefGoogle ScholarPubMed
9.Solomon, DA, Keller, MB, Leon, AC, et al.Multiple recurrences of major depressive disorder. Am J Psychiatry. 2000;157(2):229–233.CrossRefGoogle ScholarPubMed
10.Kendler, KS, Thornton, LM, Gardner, CO. Stressful life events and previous episodes in the etiology of major depression in women: an evaluation of the “kindling” hypothesis. Am J Psychiatry. 2000;157(8):1243–1251.CrossRefGoogle ScholarPubMed
11.American Psychiatric Association. Practice Guideline for the Treatment of Patients With Major Depressive Disorder. Second Edition. Arlington, Va: American Psychiatric Association; 2000.Google Scholar
12.Frank, E, Kupfer, DJ, Perel, JM, et al.Three-year outcomes for maintenance therapies in recurrent depression. Arch Gen Psychiatry. 1990;47(12):1093–1099.CrossRefGoogle ScholarPubMed
13.JF, Greden. Physical symptoms of depression: unmet needs. J Clin Psychiatry. 2003;64(suppl 7):5–11.Google Scholar
14.GE, Simon. Long-term prognosis of depression in primary care. Bull World Health Organ. 2000;78(4):439–445.Google Scholar
15.Trivedi, MH, Rush, AJ, Wisniewski, SR, et al.Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: implications for clinical practice. Am J Psychiatry. 2006;163(1):28–40.CrossRefGoogle ScholarPubMed
16.Paykel, ES, Ramana, R, Cooper, Z, Hayhurst, H, Kerr, J, Barocka, A. Residual symptoms after partial remission: an important outcome in depression. Psychol Med. 1995;25(6):1171–1180.CrossRefGoogle ScholarPubMed
17.Judd, LL, Akiskal, HS, Maser, JD, et al.A prospective 12-year study of subsyndromal and syndromal depressive symptoms in unipolar major depressive disorders. Arch Gen Psychiatry. 1998;55(8):694–700.CrossRefGoogle ScholarPubMed
18.RC, Kessler. The effects of stressful life events on depression. Annu Rev Psychol. 1997;48:191–214.Google Scholar
19.Lustman, PJ, Clouse, RE, Nix, BD, et al.Sertraline for prevention of depression recurrence in diabetes mellitus: a randomized, double-blind, placebo-controlled trial. Arch Gen Psychiatry. 2006;63(5):521–529.CrossRefGoogle ScholarPubMed
20.Kessler, RC, McGonagle, KA, Nelson, CB, Hughes, M, Swartz, M, Blazer, DG. Sex and depression in the National Comorbidity Survey. II: Cohort effects. J Affect Disord. 1994;30(1):15–26.CrossRefGoogle ScholarPubMed
21.Montgomery, SA, Dufour, H, Brion, S, et al.The prophylactic efficacy of fluoxetine in unipolar depression. Br J Psychiatry. 1988;153(3):69–76.CrossRefGoogle Scholar
22.Georgotas, A, McCue, RE, Cooper, TB. A placebo-controlled comparison of nortriptyline and phenelzine in maintenance therapy of elderly depressed patients. Arch Gen Psychiatry. 1989;46(9):783–786.Google ScholarPubMed
23.Kupfer, DJ, Frank, E, Perel, JM, et al.Five-year outcome for maintenance therapies in recurrent depression. Arch Gen Psychiatry. 1992;49(10):769–773.CrossRefGoogle ScholarPubMed
24.Keller, MB, Kocsis, JH, Thase, ME, et al.Maintenance phase efficacy of sertraline for chronic depression: a randomized controlled trial. JAMA. 1998;280(19):1665–1672.CrossRefGoogle ScholarPubMed
25.Terra, JL, Montgomery, SA. Fluvoxamine prevents recurrence of depression: results of a long-term, double-blind, placebo-controlled study. Int Clin Psychopharmacol. 1998;13(2):55–62.CrossRefGoogle ScholarPubMed
26.Gilaberte, I, Montejo, AL, de la Gandara, J, et al.Fluoxetine in the prevention of depressive recurrences: a double-blind study. J Clin Psychopharmacol. 2001;21(4):417–424.CrossRefGoogle ScholarPubMed
27.Hochstrasser, B, Isaksen, PM, Koponen, H, et al.Prophylactic effect of citalopram in unipolar, recurrent depression: placebo-controlled study of maintenance therapy. Br J Psychiatry. 2001;178:304–310.CrossRefGoogle ScholarPubMed
28.Gelenberg, AJ, Trivedi, MH, Rush, AJ, et al.Randomized, placebo-controlled trial of nefazodone maintenance treatment in preventing recurrence in chronic depression. Biol Psychiatry. 2003;54(8):806–817.CrossRefGoogle ScholarPubMed
29.Montgomery, SA, Entsuah, R, Hackett, D, Kunz, NR, Rudolph, RL. Venlafaxine versus placebo in the preventive treatment of recurrent major depression. J Clin Psychiatry. 2004;65(3):328–336.CrossRefGoogle ScholarPubMed
30.Alexopoulos, GS, Meyers, BS, Young, RC, et al.Executive dysfunction and long-term outcomes of geriatric depression. Arch Gen Psychiatry. 2000;57(3):285–290.CrossRefGoogle ScholarPubMed
31.Kane, JM, Quitkin, FM, Rifkin, A, Ramos-Lorenzi, JR, Nayak, DD, Howard, A. Lithium carbonate and imipramine in the prophylaxis of unipolar and bipolar II illness: a prospective, placebo-controlled comparison. Arch Gen Psychiatry. 1982;39(9):1065–1069.CrossRefGoogle ScholarPubMed
32.Kocsis, JH, Thase, ME, Trivedi, MH, et al.Prevention of recurrent episodes of depression with venlafaxine ER in a 1-year maintenance phase from the PREVENT Study. J Clin Psychiatry. 2007;68(7):1014–1023.CrossRefGoogle Scholar
33.Keller, MB, Trivedi, MH, Thase, ME, et al.The Prevention of Recurrent Episodes of Depression with Venlafaxine for Two Years (PREVENT) Study: Outcomes from the 2-year and combined maintenance phases. J Clin Psychiatry. 2007;68(8):1246–1256.CrossRefGoogle ScholarPubMed
34.Reynolds, CF III, Dew, MA, Pollock, BG, et al.Maintenance treatment of major depression in old age. N Engl J Med. 2006;354(11):1130–1138.CrossRefGoogle ScholarPubMed
35.Franchini, L, Gasperini, M, Perez, J, Smeraldi, E, Zanardi, R. A double-blind study of long-term treatment with sertraline or fluvoxamine for prevention of highly recurrent unipolar depression. J Clin Psychiatry. 1997;58(3):104–107.CrossRefGoogle ScholarPubMed
36.Geddes, JR, Carney, SM, Davies, C, et al.Relapse prevention with antidepressant drug treatment in depressive disorders: a systematic review. Lancet. 2003;361(9358):653–661.CrossRefGoogle ScholarPubMed
37.Keller, MB, Trivedi, MH, Thase, ME, et al.The Prevention of Recurrent Episodes of Depression with Venlafaxine for Two Years (PREVENT) study: Outcomes from the Acute and Continuation Phases. Biol Psychiatry. 2007 Sep 6: [Epub ahead of print].Google Scholar
38.Hunkeler, EM, Katon, W, Tang, L, et al.Long term outcomes from the IMPACT randomised trial for depressed elderly patients in primary care. BMJ. 2006;332(7536):259–263.CrossRefGoogle ScholarPubMed
39.Fava, GA, Ruini, C, Rafanelli, C, Finos, L, Conti, S, Grandi, S. Six-year outcome of cognitive behavior therapy for prevention of recurrent depression. Am J Psychiatry. 2004;161(10):1872–1876.CrossRefGoogle ScholarPubMed