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The Research Question

Study on primary care patients taking fluoxetine for depression recurrence prevention. Results show a small benefit of maintenance SSRI with potential for discontinuation trials without harm. Valuable data for shared decision-making in primary care.

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The Research Question

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  1. The Research Question • Background: • Increasing SSRI prescription is largely driven by use of maintenance therapy • There is no evidence from RCTS for maintenance treatment in primary care patients • Question: What is the effectiveness of maintenance SSRI treatment in preventing depression recurrence in primary care patients ?

  2. What the Researchers Did • Multicentre, placebo controlled, double blinded RCT • Intervention: continuation of maintenance SSRI vs discontinuation (taper to placebo) • Population: primary care treated patients currently taking fluoxetine for maintenance to prevent recurrence • Primary outcome: occurrence of moderately severe depression over 18 months

  3. What the Researchers Found • Maintenance treatment prevented a depression episode in 12.8% (23.3% vs 10.5%) p=0.005 NNT(18 mo)=8 • 7/8 patients experienced no benefit over 18 months • 6% of patients had to restart because of intolerable discontinuation symptoms, despite tapering NNH=16 • There was no harm in trialing discontinuation: no suggestion of poorer outcomes at 18 months in the taper arm (Patient relevant measures including mood, quality of life, overall psychological distress/symptoms, social and occupation functioning)

  4. What This Means for Clinical Practice • The absolute benefit of SSRIs in preventing depression recurrence in primary care is much smaller than that previously estimated • It seems reasonable to discuss these data with patients on maintenance treatment and offer a discontinuation trial to patients • This provides good primary care data for shared decision making when considering initiation of maintenance treatment

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