A systematic review of long-term studies of drug treated and non-drug treated depression
Abstract
Background The evidence base for long term antidepressant pharmacotherapy is limited. This review describes long-term outcomes of antidepressant-treated depression during the modern pharmacological era (post-1988). Methods Review of Medline, PsycInfo, EMBASE, and the Cochrane Library using keywords and controlled vocabulary terms for long-term outcome studies (10 years or more) of antidepressant-treated cohorts (with at least 1 follow-up assessment post 1988) and non-drug treated cohorts (no time frame). Manual search of references of included articles. Results Searches resulted in 24 publications on 12 naturalistic studies of antidepressant-treated cohorts (n=3901 at final follow-up). Most participants were White females with one inpatient stay. Recurrence of depression ranged from 40% to 85%. About one-quarter of individuals achieved a rating of well or improved, as many as experienced systematically poor outcomes. Frequency, duration, and severity of episodes varied substantially. Functional and social outcomes were infrequently measured. Few studies adequately assessed treatments. Outcomes for 3 non-drug treated samples with 1160 patients were no worse than outcomes achieved in antidepressant-treated cohorts. Limitations Heterogeneity of study designs and outcome definitions, and crude measures of pharmacotherapy precluded a statistical analysis. Conclusions Long-term outcomes in depression appear generally poor. No clear relationship emerged between drug treatment and po…
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Despite more than half a century of active research into depression, we are still unable to predict with confidence who will relapse or recur following treatment termination.
“Nonetheless, despite more than half a century of active research into the nature and treatment of depression, we are still unable to predict with confidence who will relapse or recur following treatment termination (Beckerman & Corbett, 2010; Hughes & Cohen, 2009).”
From Risk factors for relapse and recurrence of depression in adults and how they operate: A four-phase systematic review and meta-synthesis (2018) · cites this paper as Hughes & Cohen, 2009
Evidence on duration of depression as a prognostic indicator of recurrence is difficult to assess and suggests a possible lack of effect.
“The evidence for the duration of depression as a prognostic indicator of recurrence was difficult to assess as only two reviews (and few primary studies within them) investigated this.”
From Risk factors for relapse and recurrence of depression in adults and how they operate: A four-phase systematic review and meta-synthesis (2018) · cites this paper as Hughes & Cohen, 2009
The evidence is suggestive but not conclusive that a more severe last depressive episode is prognostically associated with worse odds of recurrence; it was rarely assessed and findings were conflicting.
“There was some evidence that a more severe last depressive episode was prognostically associated with worse odds of recurrence although this was rarely assessed in the included reviews and there was conflicting evidence with some studies finding an effect and others not.”
From Risk factors for relapse and recurrence of depression in adults and how they operate: A four-phase systematic review and meta-synthesis (2018) · cites this paper as Hughes & Cohen, 2009
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References 63 · Cited by 71
- Authors
- Hughes, S., & Cohen, D.
- Affiliations
- Florida International University (US)
- Venue
- Journal of Affective Disorders
- Publisher
- Elsevier BV
- Published
- 2009-11
- Volume
- 118
- Issue
- 1-3
- Pages
- 9-18
- ISSN
- 0165-0327 (ISSN-L)
- OpenAlex
- W2005893737
- Cited by
- 71
- References
- 63
- Citations by year
- 2026: 3 · 2025: 5 · 2023: 1 · 2022: 1 · 2021: 4 · 2020: 6 · 2019: 2 · 2018: 3 · 2017: 3 · 2016: 6 · 2015: 4 · 2014: 3 · 2013: 3 · 2012: 9
- FWCI
- 0.93
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Affective Disorders (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health
- National Institute of Mental Health
- Topics
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- depression, antidepressant treatment, long-term outcomes, depression recurrence, functional outcome, social functioning
- MeSH terms
- Adult, Antidepressive Agents, Major Depressive Disorder, Female, Follow-Up Studies, Humans, Long-Term Care, Male, Middle Aged, Cohort Studies, Treatment Outcome, Controlled Clinical Trials as Topic, Evidence-Based Medicine, Secondary Prevention
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