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Cited by 409Treatment of Major DepressionMental Health Treatment and AccessMedication Adherence and Compliance

The effects of adherence to antidepressant treatment guidelines on relapse and recurrence of depression

Melfi, Catherine A., Chawla, Anita J., Croghan, Thomas W., Hanna, Mark P., Kennedy, Sean, Sredl, Kate·1998·Archives of General Psychiatry
DOI 10.1001/archpsyc.55.12.1128
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Abstract

BACKGROUND: Depression is associated with high rates of relapse and recurrence during a patient's lifetime. Current guidelines regarding treatment recommend 4 to 9 months of continuation antidepressant therapy following remission of acute symptoms to allow more complete resolution of the episode. In this article, we test whether adherence to these recommendations reduces the likelihood of relapse or recurrence in a Medicaid population. METHODS: We used a Medicaid database covering 1989 through 1994. The sample consists of the 4052 adult patients who filled an antidepressant prescription at the time of an initial diagnosis of depression. These patients were followed up for up to 2 years. Timing and counts of antidepressant prescription claims are used to construct a proxy measure for adherence to guidelines. Relapse or recurrence is defined by evidence of a new episode requiring antidepressant treatment, hospital admission for depression, electroconvulsive therapy, emergency department visit for mental health, or attempted suicide. We used survival analysis to predict relapse or recurrence for each patient and to examine the effect of following treatment guidelines on relapse and recurrence. RESULTS: Approximately one fourth of the patients had a relapse or recurrence during their follow-up period. Factors that affect relapse and recurrence include comorbidities, race, and guideline adherence. Those who continued therapy with their initial antidepressant were least likely to experience relapse or recurrence; those who discontinued their antidepressant early were most likely to experience relapse or recurrence. CONCLUSION: Adherence to depression treatment guidelines with an antidepressant that is likely to have continuous use by patients reduces the probability of relapse or recurrence.

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  • The second criterion with which most authors agree is antidepressant treatment, with some mentioning it in general and others specifying change, upward adjustment, review, or potentiation.

    “The second criterion with which most authors agree is that related to antidepressant treatment, although some mention it in general (27, 33) and others specify whether they consider a change of antidepressant (8, 15, 26, 34, 40, 42, 48, 50), an upward adjustment (10, 17, 40, 45), a review of the treatment (24) or a potentiation (17).”

    From Administrative criteria in the relapse of depressive disorder: a critical appraisal (2026) · cites this paper as [27]

  • 3 articles mention Emergency visit as a possible indicator of relapse.

    “Finally, 3 articles mention Emergency visit as a possible indicator of relapse (1, 26, 27).”

    From Administrative criteria in the relapse of depressive disorder: a critical appraisal (2026) · cites this paper as [27]

  • Necessity of ECT is mentioned 13 times as an administrative criterion.

    “and necessity of ECT 13 times (1, 8, 16, 17, 19, 21, 26, 27, 38, 40, 46, 48, 50, 52).”

    From Administrative criteria in the relapse of depressive disorder: a critical appraisal (2026) · cites this paper as [27]

  • Suicide/suicide attempt is mentioned 19 times as an administrative criterion.

    “Suicide/suicide attempt is mentioned 19 times (1, 15, 16, 18, 19, 26, 27, 33, 37, 38, 41, 43–46, 48–50, 52)”

    From Administrative criteria in the relapse of depressive disorder: a critical appraisal (2026) · cites this paper as [27]

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Authors
Melfi, C. A., Chawla, A. J., Croghan, T. W., Hanna, M. P., Kennedy, S., & Sredl, K.
Affiliations
Eli Lilly (United States) (US)
ORCID
Venue
Archives of General Psychiatry
Publisher
American Medical Association (AMA)
Published
1998-12-01
Volume
55
Issue
12
Pages
1128
ISSN
0003-990X (ISSN-L)
DOI
10.1001/archpsyc.55.12.1128
OpenAlex
W2022287986
Cited by
409
References
20
Citations by year
2026: 4 · 2025: 4 · 2024: 7 · 2023: 8 · 2022: 7 · 2021: 9 · 2020: 9 · 2019: 14 · 2018: 4 · 2017: 9 · 2016: 15 · 2015: 17 · 2014: 11 · 2013: 21 · 2012: 25
FWCI
7.56
Type
journal article
Language
en
Open access
closed
Locations
  • Archives of General Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
Funders
Eli Lilly and Company
Topics
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
Keywords
depression, relapse, recurrence, antidepressant treatment, continuation treatment, guideline adherence, Medicaid, antidepressant prescribing, comorbidities, race, suicide attempts, electroconvulsive therapy
MeSH terms
Adolescent, Adult, Aged, Aged, 80 and over, Antidepressive Agents, Antidepressive Agents, Tricyclic, Depressive Disorder, Female, Follow-Up Studies, Humans, Male, Medicaid, Middle Aged, Patient Compliance, Drug Prescriptions, Research Design, United States, Proportional Hazards Models, Survival Analysis, Selective Serotonin Reuptake Inhibitors, Secondary Prevention

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