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Effects of antidepressant medicines on preventing relapse of unipolar depression: a pooled analysis of parametric survival curves

Published online by Cambridge University Press:  05 June 2020

Dongdong Zhou
Affiliation:
Mental Health Center, University-Town Hospital of Chongqing Medical University, Chongqing, China
Zhen Lv
Affiliation:
Mental Health Center, University-Town Hospital of Chongqing Medical University, Chongqing, China
Lei Shi
Affiliation:
Mental Health Center, University-Town Hospital of Chongqing Medical University, Chongqing, China
Xiaoxin Zhou
Affiliation:
Medical Department, University-Town Hospital of Chongqing Medical University, Chongqing, China
Qingxia Lin
Affiliation:
Department of Psychiatry, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang Province, China
Xiaorong Chen
Affiliation:
Mental Health Center, University-Town Hospital of Chongqing Medical University, Chongqing, China
Liyang Wan
Affiliation:
Mental Health Center, University-Town Hospital of Chongqing Medical University, Chongqing, China
Yao Li
Affiliation:
Mental Health Center, University-Town Hospital of Chongqing Medical University, Chongqing, China
Liuyi Ran
Affiliation:
Mental Health Center, University-Town Hospital of Chongqing Medical University, Chongqing, China
Yan Huang
Affiliation:
GCP Office, Chongqing Traditional Chinese Medicine Hospital, Chongqing, China
Gaomao Wang
Affiliation:
Mental Health Center, University-Town Hospital of Chongqing Medical University, Chongqing, China
Daqi Li
Affiliation:
Mental Health Center, University-Town Hospital of Chongqing Medical University, Chongqing, China
Wo Wang
Affiliation:
Mental Health Center, University-Town Hospital of Chongqing Medical University, Chongqing, China
Chuan Liu*
Affiliation:
Mental Health Center, University-Town Hospital of Chongqing Medical University, Chongqing, China
Li Kuang*
Affiliation:
Mental Health Center, University-Town Hospital of Chongqing Medical University, Chongqing, China Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
*
Authors for correspondence: Li Kuang, E-mail: kuangli0308@163.com; or Chuan Liu, E-mail: 278132435@qq.com
Authors for correspondence: Li Kuang, E-mail: kuangli0308@163.com; or Chuan Liu, E-mail: 278132435@qq.com

Abstract

Background

Major depressive disorder is characterized by a high risk of relapse. We aimed to compare the prophylactic effects of different antidepressant medicines (ADMs).

Methods

PubMed, Cochrane Central Register of Controlled Trials, Embase and the Web of Science were searched on 4 July 2019. A pooled analysis of parametric survival curves was performed using a Bayesian framework. The main outcomes were hazard ratios (HRs), relapse-free survival and mean relapse-free months.

Results

Forty randomized controlled trials were included. The 1-year relapse-free survival for ADM (76%) was significantly better than that for placebo (56%). Most of the relapse difference (86.5%) occurred in the first 6 months. Most HRs were not constant over time. Proof of benefit after 6 months of follow-up was not established partially because of small differences between the drug and placebo after 6 months. Almost all studies used an ‘enriched’ randomized discontinuation design, which may explain the high relapse rates in the first 6 months after randomization.

Conclusions

The superiority of ADM v. placebo was mainly attributed to the difference in relapse rates that occurred in the first 6 months. Our analysis provided evidence that the prophylactic efficacy was not constant over time. A beneficial effect was observed, but the prevention of new episodes after 6 months was questionable. These findings may have implications for clinical practice.

Type
Original Article
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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Footnotes

*

Contributed equally to this manuscript.

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