# Incidence of Major Depressive Disorder Relapse and Effectiveness of Pharmacologic and Psychological Interventions in Primary Care: A Systematic Review and Meta-Analysis: Incidence de la rechute du trouble dépressif majeur et efficacité des interventions pharmacologiques et psychologiques en soins primaires : revue systématique et méta-analyse

## TL;DR

This study finds that both medication and non-medication treatments can reduce depression relapse in primary care, with combined therapies being most effective.

## Contribution

The study provides a comprehensive meta-analysis of MDD relapse prevention in primary care, comparing pharmacological and psychological interventions.

## Key findings

- Pharmacotherapy and non-pharmacotherapy similarly reduce MDD relapse rates.
- Combination therapies show further reduction in relapse compared to single treatments.
- Subgroup analyses reveal significant insights based on study design and follow-up duration.

## Abstract

This research aims to investigate the relapse rates of major depressive disorder (MDD) within primary care and evaluate the efficacy of relapse prevention therapies. Despite primary care being the common point of contact for MDD patients, there are limited studies around this.

We included randomized controlled trials and observational studies examining MDD relapse incidence and the effect of pharmacological and non-pharmacological interventions in preventing relapse in primary care. Databases; Medline via Ovid, EMBASE, The Cochrane Library, PsycInfo (ebsco), and Clinical Trials.gov were searched from their inception until September 7, 2022. Joanna Briggs Institute (JBI) appraisal instrument for methodological quality assessment was used. A proportional data analysis estimated the MDD relapse incidence. Therapy effectiveness results were shown as odds ratios with 95% confidence intervals, with heterogeneity explored via subgroup analysis.

Out of the reviewed studies, 35 met the eligibility criteria. Quality appraisal scores varied between 73% and 96%. MDD relapse incidence was divided into subgroups, revealing that both pharmacotherapy and non-pharmacotherapy led to a similar decrease in relapse rates with combination therapies showing further reduction in relapse. Subgroup analyses by study design, follow-up length, date of study and quality of study also yielded noteworthy findings.

Our findings showed that MDD relapse rates in primary care settings can be effectively reduced by pharmacotherapy, non-pharmacotherapy, or combination therapy. Some psychological interventions might also reduce relapse likelihood. More studies are needed on individual and combined treatments over longer periods to understand their long-term impacts on MDD relapse in primary care.

How Often Depression Returns and How Well Treatments Work in Primary Care: A Review of Studies

Plain Language Summary

This study looked at how often people depression experience return of symptoms, when they are treated in primary care settings, such as family doctor clinics, and how well different treatments work to prevent this return of symptoms. Even though primary care is where many people with depression first seek help, there hasn't been much research on how to best prevent this return of symptoms in this setting. To gather information, the study looked at and summarized the studies that were published around this topic following a standard procedure. The study found that both medication and non-medication treatments were beneficial in reducing the chances of return of depression symptoms. Furthermore, using a combination of treatments was even more beneficial. The study also found interesting results when looking at different factors like the type of study and follow-up duration. In conclusion, this study suggests that various treatment options can effectively reduce return of depression symptoms in primary care. This includes medications, psychological therapies, or a combination of both. However, more research is needed to better understand how these treatments work over longer periods and their long-term effects people with depression.