Relapse prevention interventions effective in MDD

In patients with remitted major depressive disorder (MDD), the use of psychological relapse prevention interventions, whether as a standalone or in combination with medication, effectively reduces the risk of relapse/recurrence, according to a recent meta-analysis.

A total of 36 randomized controlled trials were included in the current quantitative analysis, all retrieved from the databases of PubMed, PsycINFO, and Embase. Trials compared relapse prevention interventions, such as cognitive behavioural therapy and mindfulness-based therapies, against treatment as usual (TAU). Outcomes included the percentage of patients relapsing and time to relapse.

Twenty-one studies compared relapse prevention strategies with TAU for ≤24 months of follow-up, yielding a total sample size of 2,715 patients. Pooled analysis found that prevention interventions were superior to TAU, significantly reducing the risk of relapse by nearly 25 percent (risk ratio [RR], 0.76, 95 percent confidence interval [CI], 0.68–0.86; p<0.001).

In the relapse prevention group, 34.7 percent of participants eventually experienced relapse, a significantly lower proportion than that in the TAU group, where 47.2 percent relapsed (summary adjusted RR, 0.80, 95 percent CI, 0.70–0.92).

These findings were robust in the long run. Over an average follow-up of >3 years, relapse risk remained more than 20 percent lower in those who received prevention interventions vs TAU (RR, 0.78, 95 percent CI, 0.62–0.98; p=0.036).

“Psychological relapse prevention interventions should be considered for all patients in remission from MDD,” the researchers said.

“Due to a paucity of data, no conclusions could be drawn with regard to the effectiveness of relapse prevention interventions for anxiety disorders and the effectiveness of relapse prevention interventions combined with discontinuation of antidepressant medication. Future studies should focus on these topics,” they added.