Psychological intervention during tapering an alternative to long-term antidepressant use

Delivery of a psychological intervention during a patient’s antidepressant tapering may be an alternative long-term antidepressant use for treating recurrent depression, according to study results published in JAMA Psychiatry.

“In the case of recurrent depression, attempts to identify moderators or predictors associated with outcomes use individual randomized clinical trials (RCTs), meta-analyses or narrative reviews,” Josefien J. F. Breedvelt, MSc, of the department of psychiatry at Amsterdam University Medical Center in the Netherlands, and colleagues wrote. “The clinical value of meta-analyses is limited because they only summarize aggregate data, without allowing the differentiation of different patient profiles and treatment responses. By pooling individual RCT data, an individual participant data meta-analysis offers more power and precision than an individual trial or meta-analysis.”

In the current individual participant data meta-analysis, the researchers aimed to compare links between psychological intervention use during and/or after antidepressant use with antidepressant use alone on risk for depression relapse and estimate associations between individual clinical factors and relapse. They searched four databases and included four RCTs that compared psychological intervention use during antidepressant medication tapering with antidepressant monotherapy, and study participants had to in full or partial depression remission. The researchers analyzed individual data from 714 participants (mean age, 49.2 years; 73.1% women). Time to relapses and relapse status over 15 months evaluated by a blinded assessor via a diagnostic clinical interview served as the main outcomes.

Results of two-stage random-effects meta-analysis showed no significant difference in time to relapse when comparing psychological intervention use during antidepressant medication tapering with antidepressant monotherapy (HR = 0.86; 95% CI, 0.6-1.23). Factors linked to higher overall risk for relapse included younger age at onset (HR = 0.98; 95% CI, 0.97-0.99), shorter duration of remission (HR = 0.99; 95% CI, 0.98-1) and higher levels of residual depressive symptoms at baseline (HR = 1.07; 95% CI, 1.04-1.1). The researchers observed no association between the included moderators and risk for relapse.

“The results should be interpreted with caution because depressive relapse may be mistaken for the withdrawal syndrome in the tapering conditions while a patient is receiving psychological interventions, thereby underestimating the ability of these interventions to prevent depressive relapse,” Breedvelt and colleagues wrote. “However, the hope is that these results further inform future personalized medicine research, advance shared decision-making and inform clinical guidelines.”