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Differential Sensitivity to Treatment Discontinuation in Single vs. Recurrent Depressive Episodes: Meta-Analysis

This meta-analysis compares the impact of treatment discontinuation in patients with single versus recurrent depressive episodes. Findings suggest that antidepressants significantly decrease the risk of relapse, particularly in patients with multiple previous episodes. However, abrupt discontinuation of antidepressants may lead to reduced preventive effects in recurrent cases. The study highlights the importance of continued treatment to lower the risk of relapse in depression.

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Differential Sensitivity to Treatment Discontinuation in Single vs. Recurrent Depressive Episodes: Meta-Analysis

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  1. Evidence That Patients With Single Versus Recurrent Depressive Episodes Are Differentially Sensitive to Treatment Discontinuation: A Meta-Analysis of Placebo-Controlled Randomized Trials Kaymaz N, van Os J, Loonen AJ, Nolen WA J Clin Psychiatry 2008; 69:1423-1436

  2. Opzet • 30 RCTs met 4890 pat. • In remissie na acute behandeling • Vervolg/onderhoudsbehandeling met AD vs. PLA • Duur stabilisatiefase: 8x 0 wk, 2x niet beschreven, 2x 2 wk 6x 24 wk, 9x 16-20 wk, 2x > 52 wk

  3. Welke antidepressiva? • 14 studies SSRI • 14 studies TCA • 2 studies ander AD

  4. Terugval volgens meetinstrument? • 8 x HAM-D • 6 x MADRS • Rest “klinisch” CGI

  5. Effectiviteit • Vervolgbehandeling met antidepressiva verkleint de kans op terugval: • OR= 0.30 (95% CI: 0.25-0.35) • Geldt zowel voor SSRIs: OR= 0.24 • Als voor TCAs: OR= 0.29

  6. Effectiviteit (vervolg) • A. Duur van de vervolgfase vóór randomisatie: • 1-3 mnd vs. 3-6 mnd vs. < 1mnd: geen verschil ! • B. AD reduceerden het risico op terugval significant, • 3,6,9 en 12 mnd na randomisatie. • Vanaf 3 mnd na randomisatie geen verdere risicoreductie

  7. Aantal eerdere episoden • Effect vervolgbehandeling met AD • OR terugval 1 episode: 0.12 (0.06-0.26) • OR terugval meerdere episoden: 0.37 (0.31-0.44)

  8. Wijze van staken AD • Abrupt staken (< 1wk) = geleidelijk staken (≥ 1 wk) • Maar: in de groep met recidiverende episoden • abrupt staken AD  lager preventief effect AD • OR=0.32 vergeleken met • OR=0.11 bij geleidelijk staken

  9. Conclusies • Voortgezette behandeling met AD: • 70%  risico op terugval • Significante reductie van terugval na 3-12 mnd • Meerdere episoden: risico terugval na staken AD

  10. Limitations • Over onderhoudsbehandeling (> 1 jaar) valt geen uitspraak te doen • Studies noemden soms het AD niet, de dosering, het aantal eerdere episoden, de duur tot randomisatie • Soms geincludeerd: bipolair II, dysthymie, atypische depressie, depressie NAO

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