Sertraline in the Prevention of Depression

Doogan, D P; Caillard, Vincent

doi:10.1192/bjp.160.2.217

Cited by 237 publications

(100 citation statements)

References 8 publications

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“…Twelve trials (13 placebo comparisons) were shorter than 1 year for the randomized followup (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)29,40). These trials provide consistent evidence in favor of active drug over placebo, with the majority representing the efficacy of relapse prevention.…”

Section: Placebo-controlled Trialsmentioning

confidence: 84%

“…Trials shorter than 1 year-Twelve trials were included in our relative risk meta-analysis of trials lasting less than 1 year after randomization ( Figure 1): one on bupropion (18), three on citalopram (19,27,40), one on escitalopram (20), three on fluoxetine (21,22,29), and one each on mirtazapine (23), nefazodone (24), sertraline (25), and venlafaxine (26). The pooled relative risk of relapse was 0.54 (95% CI 0.46 to 0.62) and the NNT to prevent one additional relapse over a mean time of 8 months was 5 (95% CI: 4-6).…”

Section: Meta-analysismentioning

confidence: 99%

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Meta-analysis of Major Depressive Disorder Relapse and Recurrence With Second-Generation Antidepressants

Hansen¹,

Gaynes²,

Thieda³

et al. 2008

Psychiatric Services

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Objective-To review data on the efficacy and effectiveness of second-generation antidepressants for preventing major depression relapse and recurrence during continuation and maintenance phase treatment, respectively.Methods-MEDLINE®, EMBASE, and PsychLit; the Cochrane Library; and the International Pharmaceutical Abstracts were searched from January 1980 through April 2007 for reviews, randomized controlled trials, meta-analyses, and observational studies. Two persons independently reviewed abstracts and full text articles using a structured data abstraction form to ensure consistency in appraisal and data extraction.Findings-Four comparative trials and 23 placebo controlled trials that addressed relapse or recurrence prevention were included. Results of comparative trials have not demonstrated statistically significant differences between duloxetine and paroxetine, fluoxetine and sertraline, fluvoxamine and sertraline, and trazodone and venlafaxine. Pooled data for the class of secondgeneration antidepressants compared with placebo suggest a relatively large effect size that persists over time. The number needed to treat to prevent one additional relapse or recurrence is 5 (95% CI 4 to 6). Differences in the length of open-label treatment prior to randomization, drug type, and trial duration did not affect pooled estimates of relapse rates (P = 0.716, P = 0.507, and P = 0.480, aCorresponding author and reprint address:

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Section: Placebo-controlled Trialsmentioning

confidence: 84%

Section: Meta-analysismentioning

confidence: 99%

Meta-analysis of Major Depressive Disorder Relapse and Recurrence With Second-Generation Antidepressants

Hansen¹,

Gaynes²,

Thieda³

et al. 2008

Psychiatric Services

View full text Add to dashboard Cite

show abstract

“…This is not an insignificant problem since recurrence rates vary from 15 to 40% in long-term clinical trials, a proportion mirrored in clinical practice (Coppen et al, 1978;Prien et al, 1973Prien et al, , 1984Montgomery et al, 1988;Rouillon et al, 1989;Frank et al, 1990;Doogan and Caillard, 1992;Kupfer et al, 1992;Montgomery and Dunbar, 1993). Patients who relapse in spite of continuing their treatment may be demoralized and refuse further treatment.…”

Section: Introductionmentioning

confidence: 99%

Placebo-Controlled Continuation Treatment with Mirtazapine: Acute Pattern of Response Predicts Relapse

Nierenberg

Quitkin

Kremer³

et al. 2004

Neuropsychopharmacol

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Pattern of response to antidepressants has been proposed as a method to identify patients whose improvement is more likely due to drug vs those whose improvement on drug is more likely to be a placebo effect. It is hypothesized that those with 'true-drug initial response pattern' are most likely to benefit from continuation treatment. The relationship between acute patterns of response and subsequent placebo-controlled continuation treatment with the antidepressant mirtazapine is examined. A total of 410 outpatients were treated openly with mirtazapine for 8-12 weeks. Patients who remitted in the acute phase were randomized to continue the same dose of mirtazapine or switched to placebo. Acute phase responders were classified as 'placebo initial response pattern' (early responders and nonpersistent responders) and 'true-drug initial response pattern' (delayed and persistent responders). Of those with a 'true-drug initial response pattern,' 10/40 (25.0%) relapsed with continuation mirtazapine, and 23/41 (56.1%) relapsed when switched to placebo. The difference (31.1%) is significant. Of those with a 'placebo initial response pattern,' 5/36 (13.9%) relapsed with continuation mirtazapine, and 12/39 (30.8%) relapsed with placebo substitution. This difference (16.9%) is not statistically significant. Moreover, the relapse rate for 'true-drug initial response pattern' patients switched to placebo (56.1%) was also significantly greater than for 'placebo initial response pattern' patients switched to placebo (30.8%). It has been suggested that patients with late onset and persistence are more likely to have improved because of drug. This hypothesis gains support from this study because of the different relapse rates of 'true-drug' responders on drug and placebo. The low relapse rate for patients with an acute placebo pattern switched to placebo suggests specific drug effect played a smaller role in their initial improvement.

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“…Placebo-controlled continuation studies with adults have shown that continued treatment with an anti-depressant for 6-9 months after acute treatment reduces relapse rates compared with placebo (14)(15)(16). In a small pilot study conducted as part of a large acute efficacy trial of fluoxetine in children and adolescents, continued fluoxetine reduced relapse rates compared with placebo (34% and 60%, respectively) and lengthened the time to relapse (17).…”

mentioning

confidence: 99%

Fluoxetine Versus Placebo in Preventing Relapse of Major Depression in Children and Adolescents

Emslie¹,

Kennard²,

Mayes³

et al. 2008

AJP

159

103

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Objective-The authors compared fluoxetine and placebo in continuation treatment to prevent relapse of major depressive disorder in children and adolescents.Method-After a detailed evaluation, children and adolescents 7-18 years of age with major depressive disorder were treated openly with fluoxetine. Those who had an adequate response after 12 weeks, as indicated by a Clinical Global Impression improvement score of 1 or 2 and a decrease of at least 50% in Children's Depression Rating Scale-Revised score, were randomly assigned to receive fluoxetine or placebo for an additional 6 months. The primary outcome measures were relapse and time to relapse. Relapse was defined as either a score of 40 or higher on the Children's Depression Rating Scale with a history of 2 weeks of clinical deterioration, or clinical deterioration as judged by the clinician. Additional analyses were conducted with relapse defined only as a score of 40 or higher on the Children's Depression Rating Scale.Results-Of 168 participants enrolled in acute fluoxetine treatment, 102 were randomly assigned to continuation treatment with fluoxetine (N=50) or placebo (N=52). Of these, 21 participants (42.0%) in the fluoxetine group relapsed, compared with 36 (69.2%) in the placebo group, a significant difference. Similarly, under the stricter definition of relapse, fewer participants in the fluoxetine group relapsed (N=11; 22.0%) than in the placebo group (N=25; 48.1%). Time to relapse was significantly shorter in the placebo group.Conclusions-Continuation treatment with fluoxetine was superior to placebo in preventing relapse and in increasing time to relapse in children and adolescents with major depression.Major depressive disorder is a serious disorder in the pediatric age group, with 2%-8% of children and adolescents afflicted (1,2). Youths with depression often have significant impairment in relationships, school, and work and are at increased risk for substance abuse, attempted and completed suicide, and depression in adulthood (1,3,4). Furthermore, it appears that early-onset major depression may be a more chronic and recurrent disorder than depression that begins in adulthood (1,5). As many as 50%-75% of children with major depression have recurrent episodes (1,3). Recurrence most often occurs within 6-12 months after remission (6)(7)(8). Thus, depression is a serious disorder requiring early intervention. Treatment for major depression may be divided into three phases: acute, continuation, and maintenance treatment. Acute treatment refers to initial treatment designed to achieve response (a significant reduction in depressive symptoms) and ultimately remission (minimal or no symptoms). The goal of treatment is remission, although most randomized controlled trials include response as the primary aim. Continuation treatment follows acute treatment with the goal of preventing relapse of symptoms from the treated episode and consolidating symptom improvement for a longer duration (recovery). Continuation treatment generally lasts 4-9 mon...

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Sertraline in the Prevention of Depression

Cited by 237 publications

References 8 publications

Meta-analysis of Major Depressive Disorder Relapse and Recurrence With Second-Generation Antidepressants

Meta-analysis of Major Depressive Disorder Relapse and Recurrence With Second-Generation Antidepressants

Placebo-Controlled Continuation Treatment with Mirtazapine: Acute Pattern of Response Predicts Relapse

Fluoxetine Versus Placebo in Preventing Relapse of Major Depression in Children and Adolescents

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