in 2014 included 15 studies submitted to FDA. The meta-analysis conducted by Borges et al. To date, only one meta-analysis has focused on such design. The most common treatment to prevent relapse/recurrence of MDD in the maintenance phase is to continue the same antidepressant medication that the subjects responded to during the acute treatment phase, so called “enrichment design”. Consequently, it is difficult for clinicians to meaningfully interpret those data. However, the meta-analysis used as the basis for these guidelines contains information about antidepressant polypharmacy, antidepressants plus psychotherapy, and data on classes of antidepressants used for maintenance treatment that are different than those used during acute phase treatment. Several treatment guidelines recommend that patients with a major depressive episode continue antidepressant therapy for 4 to 9 months after successful acute phase treatment to prevent relapse/recurrence of the episode and up to 2 years or more of maintenance treatment at full therapeutic dose for patients with an increased risk of recurrence of MDD. The risk of relapse/recurrence is significantly reduced by continuation of antidepressant after acute treatment. The relapse/recurrence of depressive symptoms after successful acute MDD treatment is common and is a significant clinical concern. Recently, treatment goals have focused on full recovery from depression, entailing both remission of depressive symptoms and restoration of vocational and interpersonal functions. It is a chronic condition associated with significant functional impairment. Major depressive disorder (MDD) is among the most common psychiatric disorders. SSRIs are well-balanced agents, and flexible dose adjustments are more effective for relapse prevention. To prevent relapse and treatment failure, maintenance therapy, and careful attention for at least 6 months after remission is recommended. 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. The tolerability rate was ~4% for both groups. 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 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. 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 pooled odds ratio (OR) (☙5% confidence intervals (CI)) was calculated using a random effects model. 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. 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. A significant clinical issue encountered after a successful acute major depressive disorder (MDD) treatment is the relapse of depressive symptoms.
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