Psychological interventions as an alternative and add-on to antidepressant medication to prevent depressive relapse: systematic review and meta-analysis
Open accessAbstract
Background: After remission, antidepressants are often taken long term to prevent depressive relapse or recurrence. Whether psychological interventions can be a viable alternative or addition to antidepressants remains unclear. Aims: To compare the effectiveness of psychological interventions as an alternative (including delivered when tapering antidepressants) or addition to antidepressants alone for preventing depressive relapse. Method: Embase, PubMed, the Cochrane Library and PsycINFO were searched from inception until 13 October 2019. Randomised controlled trials (RCTs) with previously depressed patients in (partial) remission where preventive psychological interventions with or without antidepressants (including tapering) were compared with antidepressant control were included. Data were extracted independently from published trials. A random-effects meta-analysis on time to relapse (hazard ratio, HR) and risk of relapse (risk ratio, RR) at the last point of follow-up was conducted. PROSPERO ID: CRD42017055301. Results: Among 11 included trials (n = 1559), we did not observe an increased risk of relapse for participants receiving a psychological intervention while tapering antidepressants versus antidepressants alone (RR = 1.02, 95% CI 0.84–1.25; P = 0.85). Psychological interventions added to antidepressants significantly reduced the risk of relapse (RR = 0.85, 95% CI 0.74–0.97; P = 0.01) compared with antidepressants alone. Conclusions: This study found no evidence to suggest that adding a psychological intervention to tapering increases the risk of relapse when compared with antidepressants alone. Adding a psychological intervention to antidepressant use reduces relapse risk significantly versus antidepressants alone. As neither strategy is routinely implemented these findings are relevant for patients, clinicians and guideline developers.
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The combination of psychological interventions and antidepressants effectively decreases the risk of relapse in cases of MDD.
“Specifically, the combination of psychological interventions and antidepressants effectively decreases the risk of relapse in cases of MDD. 424 – 426”
From Major depressive disorder: hypothesis, mechanism, prevention and treatment (2024) · cites this paper as [425]
Only one meta-analysis studied the effect of adding psychological interventions to ADM, and found that this significantly reduces relapse risks when compared to ADM only.
“Although meta-analyses have reported results of studies allowing the use of M-ADM, only one meta-analysis studied the effect of adding psychological interventions to ADM, and found that this significantly reduces relapse risks when compared to ADM only [50].”
From Psychological interventions to prevent relapse in anxiety and depression: A systematic review and meta-analysis (2022) · cites this paper as [50]
Previous meta-analyses contain very little information about the effectiveness of adding psychological interventions to M-ADM or the discontinuation of ADM.
“Previous meta-analyses contain very little information about the effectiveness of adding psychological interventions to M-ADM or the discontinuation of ADM, even though this approach could be promising for preventing relapse [49, 50].”
From Psychological interventions to prevent relapse in anxiety and depression: A systematic review and meta-analysis (2022) · cites this paper as [50]
Other meta-analyses mostly compared psychological interventions to ADM, and only one meta-analysis studied the additional effect of psychological interventions.
“Other meta-analyses mostly compared psychological interventions to ADM [44, 46, 48], and only one meta-analysis studied the additional effect of psychological interventions [50].”
From Psychological interventions to prevent relapse in anxiety and depression: A systematic review and meta-analysis (2022) · cites this paper as [50]
Incorporating psychological interventions alongside antidepressant medications has augmented benefit.
“In light of these challenges, several studies indicate the augmented benefit of incorporating psychological interventions alongside antidepressant medications (Breedvelt 2021; Thapar 2022; Verhoeven 2023).”
From Psychotherapeutic treatments for depression in older adults (2024) · cites this paper as Breedvelt 2021
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“Although meta-analyses have reported results of studies allowing the use of M-ADM, only one meta-analysis studied the effect of adding psychological interventions to ADM, and found that this significantly reduces relapse risks when compared to ADM only [50].”
MethodResultPsychotherapeutic treatments for depression in older adults
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Self-citation
- Authors
- Breedvelt, J. J. F., Brouwer, M. E., Harrer, M., Semkovska, M., Ebert, D. D., Cuijpers, P., & Bockting, C. L. H.
- Affiliations
- Mental Health Foundation (GB)
- Friedrich-Alexander-Universität Erlangen-Nürnberg (DE)
- University of Southern Denmark (DK)
- Vrije Universiteit Amsterdam (NL)
- Amsterdam University Medical Centers (NL)
- Corresponding author
- Bockting, Claudi Louisa Hermina
- ORCID
- Venue
- The British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2020-11-18
- Volume
- 219
- Issue
- 4
- Pages
- 538-545
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W3104156641
- Cited by
- 41
- References
- 37
- Citations by year
- 2026: 9 · 2025: 6 · 2024: 7 · 2023: 5 · 2022: 9 · 2021: 5
- FWCI
- 0.62
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- mediaTUM (Technical University of Munich) (submittedVersion)
- VU Research Portal (submittedVersion, other-oa)
- University of Southern Denmark Research Portal (University of Southern Denmark) (submittedVersion, other-oa)
- Funders
- Amsterdam University Medical Centers
- Universiteit van Amsterdam
- Vrije Universiteit Amsterdam
- Syddansk Universitet
- Topics
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- psychological intervention, antidepressant tapering, antidepressants, depression relapse, depression prevention, relapse prevention, combination therapy, remitted depression, time to relapse
- MeSH terms
- Psychosocial Intervention, Antidepressive Agents, Chronic Disease, Humans, Recurrence
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