Predicting relapse in major depression after successful initial pharmacological treatment

Tatsuo Akechi; Akio Mantani; Ken'ichi Kurata; Susumu Hirota; Shinji Shimodera; Mitsuhiko Yamada; Masatoshi Inagaki; Norio Watanabe; Tadashi Kato; Toshi A Furukawa; SUND Investigators

doi:10.1016/j.jad.2019.03.004

Predicting relapse in major depression after successful initial pharmacological treatment

J Affect Disord. 2019 May 1:250:108-113. doi: 10.1016/j.jad.2019.03.004. Epub 2019 Mar 5.

Authors

Affiliations

¹ Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan. Electronic address: takechi@med.nagoya-cu.ac.jp.
² Mantani Mental Clinic, Hiroshima, Japan.
³ Kabe Mental Health Clinic, Hiroshima, Japan.
⁴ Hirota Clinic, Hiroshima, Japan.
⁵ Department of Neuropsychiatry, Kochi Medical School, Kochi, Japan.
⁶ Department of Neuropsychopharmacology, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan.
⁷ Department of Neuropsychiatry, Okayama University Hospital, Okayama, Japan.
⁸ Kyoto University Graduate School of Medicine, School of Public Health Department of Health Promotion of Human Behavior, Kyoto, Japan.
⁹ Aratama Kokorono Clinic, Nagoya, Japan.

PMID: 30851699
DOI: 10.1016/j.jad.2019.03.004

Abstract

Background: Identifying the predictors of relapse could help to develop more individualized treatment strategies for major depression. The study aim was to explore predictors of depression relapse after remission using data from our previous multicenter randomized practical trial of patients with major depression.

Methods: Our cohort comprised subjects with Patient Health Questionnaire (PHQ-9) scores less than 5 after antidepressant treatment for 9 weeks. Relapse was defined as a PHQ-9 score of 5 or more at week 25. We examined patient demographic and clinical characteristics at baseline (age, sex education, job status, marital status, onset age at first depressive episode, number of previous episodes, length of current episode, scores on the nine PHQ-9 criteria at week 0) and Frequency, Intensity, and Burden of Side Effects Rating Scale and PHQ-9 total scores at week 9 (residual symptoms) as potential predictors of depression relapse at week 25.

Results: Of 494 patients remitted at week 9, 71 (14.4%) experienced relapse at week 25. Logistic regression analysis showed that lower PHQ-9 depressive mood score at week 0, higher suicidal ideation score at week 0, and total PHQ-9 score at week 9, and greater severity of side effects at week 9 were significant predictors. On the other hand, when relapse was defined as a PHQ-9 score of 10 or more at week 25, there were no significant predictors.

Limitations: There may be other important predictors that this study failed to identify and the findings obtained may be sensitive to the specific definition of relapse.

Conclusions: Approximately one-seventh of subjects who remitted after 2 months of acute-phase treatment experienced depression relapse within 4 months of remission. Lower depressive mood and higher suicidal ideation upon development of the current depression episode, the presence of residual symptoms, and greater severity of side effects at remission may predict subsequent depression relapse.

Keywords: Antidepressant; Major depression; Predictor; Relapse.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Antidepressive Agents / therapeutic use*
Depressive Disorder, Major / drug therapy
Depressive Disorder, Major / psychology*
Female
Humans
Male
Middle Aged
Patient Health Questionnaire / statistics & numerical data*
Recurrence
Suicidal Ideation
Time Factors
Treatment Outcome

Substances

Antidepressive Agents