Efficacy of amineptine in the prevention of relapse in unipolar depression

Lau

et al. 2015

IJNPPY

175

153

Background:Findings of substantial remaining morbidity in treated major depressive disorder (MDD) led us to review controlled trials of treatments aimed at preventing early relapses or later recurrences in adults diagnosed with MDD to summarize available data and to guide further research.Methods:Reports (n = 97) were identified through systematic, computerized literature searching up to February 2015. Treatment versus control outcomes were summarized by random-effects meta-analyses.Results:In 45 reports of 72 trials (n = 14 450 subjects) lasting 33.4 weeks, antidepressants were more effective than placebos in preventing relapses (response rates [RR] = 1.90, confidence interval [CI]: 1.73–2.08; NNT = 4.4; p < 0.0001). In 35 reports of 37 trials (n = 7253) lasting 27.0 months, antidepressants were effective in preventing recurrences (RR = 2.03, CI 1.80–2.28; NNT = 3.8; p < 0.0001), with minor differences among drug types. In 17 reports of 22 trials (n = 1 969) lasting 23.7 months, psychosocial interventions yielded inconsistent or inconclusive results.Conclusions:Despite evidence of the efficacy of drug treatment compared to placebos or other controls, the findings further underscore the substantial, unresolved morbidity in treated MDD patients and strongly encourage further evaluations of specific, improved individual and combination therapies (pharmacological and psychological) conducted over longer times, as well as identifying clinical predictors of positive or unfavorable responses and of intolerability of long-term treatments in MDD.

Section: Introductionmentioning

confidence: 99%

Prevention of Relapse and Recurrence in Adults with Major Depressive Disorder: Systematic Review and Meta-Analyses of Controlled Trials

Lau

et al. 2015

IJNPPY

175

153

“…Additional continuation studies involving paroxetine, nefazodone, citalopram, reboxetine, amineptine and fluoxetine, with nearly identical protocol designs, gave very similar results (Montgomery & Dunbar, 1993; Montgomery et al , 1993; Robert & Montgomery, 1995; Ferreri et al , 1997; Reimherr et al , 1998; Feiger et al , 1999; Versiani et al , 1999). Approximately one-third to one-half of patients who did not continue active treatment after stabilisation (i.e.…”

Section: Continuation Treatmentmentioning

confidence: 86%

Clinical importance of long-term antidepressant treatment

Hirschfeld

2001

Br J Psychiatry

BackgroundDepression, which only a few decades ago was considered to be a short-term illness requiring short-term treatment, is now recognised as a recurrent, sometimes chronic, long-term illness.AimsTo highlight the clinical importance of long-term antidepressant therapy in the treatment of depression.MethodThe current literature was reviewed to examine the relationship between duration of antidepressant therapy and efficacy.ResultsApproximately one-third to a half of patients successfully stabilised in acute-phase treatment will relapse if medication is not sustained throughout the continuation period. Only 10–15% will relapse if medication is continued. For maintenance-phase therapy, approximately 60% of patients at risk will experience a recurrent episode of depression within I year if untreated, whereas those who continue in treatment will have a recurrence rate of between 10% and 30%.ConclusionsRisk of relapse and recurrence of depression can be significantly reduced if adequate continuation and maintenance therapy durations are achieved.

“…Five of these 60 articles described studies meeting criteria for inclusion in the present meta-analysis. These five studies [7,8,9,10,11] involved a total of 1,009 MDD outpatients who responded or remitted following treatment with either maprotiline, imipramine, amineptine, phenelzine, or paroxetine, who were then randomized to continue treatment with a full versus a reduced dose of that antidepressant (see table 1 for details).…”

Section: Resultsmentioning

confidence: 99%

Antidepressant Dose Reduction and the Risk of Relapse in Major Depressive Disorder

Papakostas

Perlis²,

Seifert³

et al. 2007

Psychother Psychosom

Background: Whether the dose of antidepressants can be reduced following clinical improvement without subsequently increasing the likelihood of depressive relapse has not been established. Thus, the aim of this work was to compare relapse rates among patients with major depressive disorder (MDD) randomized to either continue receiving the full versus a reduced dose of antidepressants following partial or full improvement of symptoms. Methods: Five double-blind, randomized clinical trials involving 1,009 patients with MDD randomized to either continue receiving the full versus a reduced dose of antidepressants following partial or full improvement of symptoms were pooled using a random-effect meta-analysis model. Results: Patients randomized to continue treatment with lower doses of antidepressants were more likely to experience a depressive relapse than patients who continued treatment with the full dose (risk ratio 1.62, 95% confidence interval: 1.52–2.80, p = 0.001). Pooled relapse rates were 25.3 and 15.1% for the two treatment groups. Conclusions: Decreasing the antidepressant dose following partial or full symptom improvement is associated with an increased risk of relapse in MDD.