Predictors of relapse following a stepwise psychopharmacotherapy regime in patients with depressive disorders

Background: Real world predictors of relapse following routine treatment for depression remain under -researched. We sought to investigate this in an outpatient clinical sample with depressive disorders receiving stepwise pharmacotherapy based on early clinical decision-making, applying a naturalistic 24-month prospective design. Methods: Patients were recruited at a University hospital in South Korea from March 2012 to April 2017. After 3-week antidepressant monotherapy (N = 1262), next treatment steps (1, 2, 3, and 4 or over) with alternative strategies (switching, augmentation, combination, and mixtures of these approaches) were administered based on measurements and patient preference at 3-week points in the acute treatment phase (3, 6, 9, and 12 weeks) (N = 1246). For those who responded [Hamilton Depression Rating Scale (HAMD) score of <= 14] (N = 937), relapse (HAMD>14) was identified every 3 months from 6 to 24 months (N = 816). Predictors of relapse were evaluated using multi-variate Cox proportional hazards models. Results: Four independent relapse predictors were identified: higher number of previous depressive episodes, higher anxiety at baseline, higher number of treatment steps, and poor medication adherence. In particular, treatment Step 4 was significantly associated with relapse compared to treatment Step 1, 2, and 3 after adjustment for relevant covariates. Limitation: Withdrawal syndromes after discontinuing psychotropic drugs, known to confound the determination of relapse, were not evaluated. The study was conducted at a single site, which maximised consistency but may limit generalizability. Conclusions: Predictors of relapse reported from more restricted trial or cohort samples were replicated in this long-term naturalistic prospective design.

Automated summary

The study identified predictors of relapse in depression treatment, including previous depressive episodes, baseline anxiety, number of treatment steps, and poor medication adherence. Results showed that treatment Step 4 was significantly associated with relapse compared to other treatment steps during the long-term follow-up.