The objective of this review was to evaluate the efficacy of selective serotonin reuptake inhibitors (SSRIs) and SSRIs compared with other treatment modalities in preventing relapse after an episode of major depressive disorder (MDD). An Ovid MEDLINE and PsycINFO search (from 1987 to August 2017) was conducted using the following terms: selective serotonin reuptake inhibitors, antidepressants, depression, prevention, prophylaxis, relapse and MDD. Using predefined criteria, two authors independently selected and reached consensus on the included studies. Sixteen articles met the criteria: 10 compared the relapse rate of selective SSRIs with placebo or other SSRIs; one discussed the effectiveness of SSRIs plus psychotherapy, two compared SSRI versus tricyclic antidepressants (TCAs), two were mainly composed of TCAs plus psychotherapy, and one compared SSRIs and serotonin norepinephrine reuptake inhibitors (SNRIs). According to the included studies, the relapse risk in adults was lower when SSRIs were combined with psychotherapy. Results comparing SSRIs and SNRIs were inconclusive. TCAs may be equally as effective as SSRIs. Atypical antidepressants (mirtazapine and St John's Wort) had no significant difference in efficacy and remission rates compared with SSRIs. Escitalopram appeared to fare better in efficacy than other SSRIs, owing to a higher prophylactic efficacy and lower side effects; however, according to the current data, this difference was not significant. To conclude, this review provides evidence that continuing SSRIs for 1 year reduces risk of MDD and relapse. Furthermore, the combination of SSRIs and cognitive behavioural therapy may effectively reduce relapse. Escitalopram appeared to yield better results and fewer side effects than did other SSRIs or SNRIs. The effectiveness in reducing relapse of SSRIs was similar to that of TCAs and atypical antidepressants.
Keywords: MDD prevention; MDD prophylaxis; SSRI; antidepressants; depression; major depression; major depressive disorder; specific serotonin reuptake inhibitor.
Conflict of interest statement
Conflict of interest statement: The authors declare that there is no conflict of interest.
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Comparison of Agomelatine and Selective Serotonin Reuptake Inhibitors/Serotonin-Norepinephrine Reuptake Inhibitors in Major Depressive Disorder: A Meta-Analysis of Head-To-Head Randomized Clinical TrialsKL Huang et al. Aust N Z J Psychiatry 48 (7), 663-71. PMID 24604920. - Meta-AnalysisAgomelatine has significantly higher efficacy and potential acceptability compared to SSRIs and SNRIs when treating MDD. However, the difference in efficacy is not consid …
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Treatment of depression should aim at full recovery, i.e., that the patient is not only symptom free but a…
Remission, Dropouts, and Adverse Drug Reaction Rates in Major Depressive Disorder: A Meta-Analysis of Head-To-Head TrialsM Machado et al. Curr Med Res Opin 22 (9), 1825-37. PMID 16968586. - Meta-AnalysisSNRIs had the highest efficacy remission rates (statistically significant for inpatients and outpatients), and the lowest overall dropout rates, suggesting clinical super …
The Economic Impact of Introducing Serotonin-Noradrenaline Reuptake Inhibitors Into the Brazilian National Drug Formulary: Cost-Effectiveness and Budget-Impact AnalysesM Machado et al. Pharmacoeconomics 25 (11), 979-90. PMID 17960955. - Meta-AnalysisSNRIs appear to be cost effective against SSRIs and TCAs when prescribed to patients with MDD in Brazil. However, their inclusion into the national drug list would genera …
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