Effects of antidepressant medicines on preventing relapse of unipolar depression: a pooled analysis of parametric survival curves
Major depressive disorder is characterized by a high risk of relapse. We aimed to compare the prophylactic effects of different antidepressant medicines (ADMs). PubMed, Cochrane Central Register of Controlled Trials, Embase and the Web of Science were searched on 4 July 2019. A pooled analysis of pa...
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| Veröffentlicht in: | Psychological medicine 2022-01, Vol.52 (1), p.48-56 |
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| creator | Zhou, Dongdong Lv, Zhen Shi, Lei Zhou, Xiaoxin Lin, Qingxia Chen, Xiaorong Wan, Liyang Li, Yao Ran, Liuyi Huang, Yan Wang, Gaomao Li, Daqi Wang, Wo Liu, Chuan Kuang, Li |
| description | Major depressive disorder is characterized by a high risk of relapse. We aimed to compare the prophylactic effects of different antidepressant medicines (ADMs).
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.
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.
The superiority of ADM
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. |
| doi_str_mv | 10.1017/S0033291720001610 |
| format | Article |
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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.
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.
The superiority of ADM
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.</description><identifier>ISSN: 0033-2917</identifier><identifier>ISSN: 1469-8978</identifier><identifier>EISSN: 1469-8978</identifier><identifier>DOI: 10.1017/S0033291720001610</identifier><identifier>PMID: 32501194</identifier><language>eng</language><publisher>Cambridge, UK: Cambridge University Press</publisher><subject>Antidepressants ; Antidepressive Agents - therapeutic use ; Bayes Theorem ; Bayesian analysis ; Chronic Disease ; Clinical medicine ; Clinical trials ; Depressive Disorder, Major - drug therapy ; Depressive Disorder, Major - prevention & control ; Depressive personality disorders ; Digitization ; Discontinued ; Drugs ; Efficacy ; High risk ; Humans ; Mental depression ; Original Article ; Patients ; Placebos ; Prevention ; Psychotropic drugs ; Recurrence ; Relapse ; Remission (Medicine) ; Survival ; Survival analysis</subject><ispartof>Psychological medicine, 2022-01, Vol.52 (1), p.48-56</ispartof><rights>Copyright © The Author(s), 2020. Published by Cambridge University Press</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c373t-eba8fdd75edad0901f6087225e5f88d028db0501f46e0aeeafa2801e3a3b5e8e3</citedby><cites>FETCH-LOGICAL-c373t-eba8fdd75edad0901f6087225e5f88d028db0501f46e0aeeafa2801e3a3b5e8e3</cites><orcidid>0000-0001-5899-7032</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.cambridge.org/core/product/identifier/S0033291720001610/type/journal_article$$EHTML$$P50$$Gcambridge$$H</linktohtml><link.rule.ids>164,314,776,780,12825,27901,27902,30976,55603</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32501194$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Zhou, Dongdong</creatorcontrib><creatorcontrib>Lv, Zhen</creatorcontrib><creatorcontrib>Shi, Lei</creatorcontrib><creatorcontrib>Zhou, Xiaoxin</creatorcontrib><creatorcontrib>Lin, Qingxia</creatorcontrib><creatorcontrib>Chen, Xiaorong</creatorcontrib><creatorcontrib>Wan, Liyang</creatorcontrib><creatorcontrib>Li, Yao</creatorcontrib><creatorcontrib>Ran, Liuyi</creatorcontrib><creatorcontrib>Huang, Yan</creatorcontrib><creatorcontrib>Wang, Gaomao</creatorcontrib><creatorcontrib>Li, Daqi</creatorcontrib><creatorcontrib>Wang, Wo</creatorcontrib><creatorcontrib>Liu, Chuan</creatorcontrib><creatorcontrib>Kuang, Li</creatorcontrib><title>Effects of antidepressant medicines on preventing relapse of unipolar depression: a pooled analysis of parametric survival curves</title><title>Psychological medicine</title><addtitle>Psychol. Med</addtitle><description>Major depressive disorder is characterized by a high risk of relapse. We aimed to compare the prophylactic effects of different antidepressant medicines (ADMs).
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.
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.
The superiority of ADM
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.</description><subject>Antidepressants</subject><subject>Antidepressive Agents - therapeutic use</subject><subject>Bayes Theorem</subject><subject>Bayesian analysis</subject><subject>Chronic Disease</subject><subject>Clinical medicine</subject><subject>Clinical trials</subject><subject>Depressive Disorder, Major - drug therapy</subject><subject>Depressive Disorder, Major - prevention & control</subject><subject>Depressive personality disorders</subject><subject>Digitization</subject><subject>Discontinued</subject><subject>Drugs</subject><subject>Efficacy</subject><subject>High risk</subject><subject>Humans</subject><subject>Mental depression</subject><subject>Original Article</subject><subject>Patients</subject><subject>Placebos</subject><subject>Prevention</subject><subject>Psychotropic drugs</subject><subject>Recurrence</subject><subject>Relapse</subject><subject>Remission (Medicine)</subject><subject>Survival</subject><subject>Survival analysis</subject><issn>0033-2917</issn><issn>1469-8978</issn><issn>1469-8978</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>7QJ</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp1kUtv1TAQhS0EopfCD2CDLLFhE5ix83DYoao8pEpdtKyjSTyuXCVxsJMrddl_ji-9gATqyiOf7xxrfIR4jfAeAZsPVwBaqxYbBQBYIzwROyzrtjBtY56K3UEuDvqJeJHSbWY0luq5ONGqAsS23In7c-d4WJMMTtK8estL5JTyKCe2fvAzZ22W-XbPWZ9vZOSRlsQHxzb7JYwU5dHmw_xRklxCGNnmPBrvkv-VvVCkidfoB5m2uPd7GuWQB04vxTNHY-JXx_NUfP98fn32tbi4_PLt7NNFMehGrwX3ZJy1TcWWLLSArgbTKFVx5YyxoIztIW_lypqBmMmRMoCsSfcVG9an4t1D7hLDj43T2k0-DTyONHPYUqdKBF3WCsuMvv0HvQ1bzNtkqkYNpi2hzRQ-UEMMKUV23RL9RPGuQ-gO_XT_9ZM9b47JW5__94_jdyEZ0MdQmvro7Q3_ffvx2J-BopyD</recordid><startdate>20220101</startdate><enddate>20220101</enddate><creator>Zhou, Dongdong</creator><creator>Lv, Zhen</creator><creator>Shi, Lei</creator><creator>Zhou, Xiaoxin</creator><creator>Lin, Qingxia</creator><creator>Chen, Xiaorong</creator><creator>Wan, Liyang</creator><creator>Li, Yao</creator><creator>Ran, Liuyi</creator><creator>Huang, Yan</creator><creator>Wang, Gaomao</creator><creator>Li, Daqi</creator><creator>Wang, Wo</creator><creator>Liu, Chuan</creator><creator>Kuang, Li</creator><general>Cambridge University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>0-V</scope><scope>3V.</scope><scope>7QJ</scope><scope>7QP</scope><scope>7QR</scope><scope>7RV</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ALSLI</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>HEHIP</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2M</scope><scope>M2O</scope><scope>M2S</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-5899-7032</orcidid></search><sort><creationdate>20220101</creationdate><title>Effects of antidepressant medicines on preventing relapse of unipolar depression: a pooled analysis of parametric survival curves</title><author>Zhou, Dongdong ; Lv, Zhen ; Shi, Lei ; Zhou, Xiaoxin ; Lin, Qingxia ; Chen, Xiaorong ; Wan, Liyang ; Li, Yao ; Ran, Liuyi ; Huang, Yan ; Wang, Gaomao ; Li, Daqi ; Wang, Wo ; Liu, Chuan ; Kuang, Li</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c373t-eba8fdd75edad0901f6087225e5f88d028db0501f46e0aeeafa2801e3a3b5e8e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Antidepressants</topic><topic>Antidepressive Agents - 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Academic</collection><jtitle>Psychological medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Zhou, Dongdong</au><au>Lv, Zhen</au><au>Shi, Lei</au><au>Zhou, Xiaoxin</au><au>Lin, Qingxia</au><au>Chen, Xiaorong</au><au>Wan, Liyang</au><au>Li, Yao</au><au>Ran, Liuyi</au><au>Huang, Yan</au><au>Wang, Gaomao</au><au>Li, Daqi</au><au>Wang, Wo</au><au>Liu, Chuan</au><au>Kuang, Li</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effects of antidepressant medicines on preventing relapse of unipolar depression: a pooled analysis of parametric survival curves</atitle><jtitle>Psychological medicine</jtitle><addtitle>Psychol. Med</addtitle><date>2022-01-01</date><risdate>2022</risdate><volume>52</volume><issue>1</issue><spage>48</spage><epage>56</epage><pages>48-56</pages><issn>0033-2917</issn><issn>1469-8978</issn><eissn>1469-8978</eissn><abstract>Major depressive disorder is characterized by a high risk of relapse. We aimed to compare the prophylactic effects of different antidepressant medicines (ADMs).
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.
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.
The superiority of ADM
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.</abstract><cop>Cambridge, UK</cop><pub>Cambridge University Press</pub><pmid>32501194</pmid><doi>10.1017/S0033291720001610</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0001-5899-7032</orcidid></addata></record> |
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| ispartof | Psychological medicine, 2022-01, Vol.52 (1), p.48-56 |
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| subjects | Antidepressants Antidepressive Agents - therapeutic use Bayes Theorem Bayesian analysis Chronic Disease Clinical medicine Clinical trials Depressive Disorder, Major - drug therapy Depressive Disorder, Major - prevention & control Depressive personality disorders Digitization Discontinued Drugs Efficacy High risk Humans Mental depression Original Article Patients Placebos Prevention Psychotropic drugs Recurrence Relapse Remission (Medicine) Survival Survival analysis |
| title | Effects of antidepressant medicines on preventing relapse of unipolar depression: a pooled analysis of parametric survival curves |
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