Prophylactic efficacy of fluoxetine, escitalopram, sertraline, paroxetine, and concomitant psychotherapy in major depressive disorder: Outcome after long-term follow-up
Abstract
The acute efficacy of selective serotonin reuptake inhibitors (SSRIs) in the treatment of major depressive disorder (MDD) is well established; however their role in longer-term prevention of recurrence remains unconfirmed. This study aims at examining: the prophylactic efficacy of four commonly used SSRIs in MDD in a naturalistic setting with long-term follow-up, the effect of concomitant cognitive behavioral therapy (CBT), and the predictors of outcome. In a prospective cohort study, 387 patients who either remitted or responded following treatment with four different SSRIs-fluoxetine, escitalopram, sertraline and paroxetine-were followed up over several years. During an average follow-up period of 34.5 months, 76.5% of patients experienced MDD recurrence. Escitalopram and fluoxetine showed a numerically higher prophylactic efficacy than paroxetine and sertraline but the difference was statistically insignificant. The prophylactic efficacy for SSRI-only treatment was limited, with a recurrence rate of 82.0%, compared to 59.0% of patient recurrence rate in concomitant Cognitive Behavioral Therapy (CBT). The relatively small size of the CBT group and the lack of randomization may undermine the extrapolation of its findings to clinical practice. Nevertheless, the study preliminary data may help in defining the clinical utility of antidepressants and CBT in the prophylaxis from MDD recurrence.
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Most studies in the third group show that the presence of subthreshold symptoms, often residual symptoms after an MDD episode, is associated with an enhanced risk of a recurrent episode or relapse.
“Most of these studies show that the presence of ‘subthreshold’ symptoms (often called residual symptoms if occurring after an MDD episode) was associated with an enhanced risk of a (recurrent) episode or relapse”
From Empirical evidence for definitions of episode, remission, recovery, relapse and recurrence in depression: a systematic review (2019) · cites this paper as Peselow et al. 2015
Multiple studies showed that those who scored below a certain threshold on depressive symptom scales had a better prognosis than those who scored above it.
“Multiple studies showed that those who scored below a certain threshold on depressive symptom scales had a better prognosis than those who scored above it”
From Empirical evidence for definitions of episode, remission, recovery, relapse and recurrence in depression: a systematic review (2019) · cites this paper as Peselow et al. 2015
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- Authors
- Peselow, E. D., Tobia, G., Karamians, R., Pizano, D., & IsHak, W. W.
- Affiliations
- Richmond University Medical Center (US)
- Wayne State University (US)
- Pepperdine University (US)
- Cedars-Sinai Medical Center (US)
- Venue
- Psychiatry Research
- Publisher
- Elsevier BV
- Published
- 2015-02
- Volume
- 225
- Issue
- 3
- Pages
- 680-686
- ISSN
- 0165-1781 (ISSN-L)
- OpenAlex
- W2030224179
- Cited by
- 19
- References
- 55
- Citations by year
- 2026: 1 · 2025: 1 · 2023: 1 · 2022: 2 · 2021: 2 · 2020: 5 · 2019: 1 · 2018: 2 · 2017: 2 · 2016: 1 · 2014: 1
- FWCI
- 0.97
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychiatry Research (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- major depressive disorder, depression recurrence, prophylaxis, selective serotonin reuptake inhibitors, fluoxetine, escitalopram, sertraline, paroxetine, cognitive behavioral therapy, long-term follow-up, prognostic factors
- MeSH terms
- Adult, Combined Modality Therapy, Depressive Disorder, Major, Major Depressive Disorder, Female, Fluoxetine, Follow-Up Studies, Humans, Long-Term Care, Male, Middle Aged, Prospective Studies, Recurrence, Citalopram, Cohort Studies, Cognitive Behavioral Therapy, Treatment Outcome, Selective Serotonin Reuptake Inhibitors, Paroxetine, Sertraline
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