Zurich Open Repository and Archive University of Zurich Main Library Strickhofstrasse 39 CH-8057 Zurich www.zora.uzh.ch Year: 2019 Comparative effectiveness of continuation and maintenance treatments for persistent depressive disorder in adults Machmutow, Katja ; Meister, R ; Jansen, A ; Kriston, L ; Watzke, Birgit ; Härter, M ; Liebherz, Sarah Abstract: Background: Persistent depressive disorder (PDD) is defined as a depressive disorder witha minimum illness duration of two years, including four diagnostic subgroups (dysthymia, chronic major depression, recurrent major depression with incomplete remission between episodes, and double depres- sion). Persistent forms of depression represent a substantial proportion of depressive disorders, with a lifetime prevalence ranging from 3% to 6% in the Western world. Growing evidence indicates that PDD responds well to several acute interventions, such as combined psychological and pharmacological treatments. Yet, given the high rates of relapse and recurrences of depression following response to acute treatment, long-term continuation and maintenance therapy are of great importance. To date, there has been no evidence synthesis available on continuation and maintenance treatments of PDDs. Objec- tives: To assess the effects of pharmacological and psychological (either alone or combined) continuation and maintenance treatments for persistent depressive disorder, in comparison with each other, placebo (drug/attention placebo/non-specific treatment control), and treatment as usual (TAU). Continuation treatments are defined as treatments given to currently remitted people (remission is defined asdepres- sive symptoms dropping below case level) or to people who previously responded to an antidepressant treatment. Maintenance therapy is given during recovery (which is defined as remission lasting longer than six months). Search methods: We searched Ovid MEDLINE (1950- ), Embase (1974- ), PsycINFO (1967- ) and the Cochrane Central Register of Controlled Trials (CENTRAL) to 28 September 2018. An earlier search of these databases was also conducted for RCTs via the Cochrane Common Mental Disorders Controlled Trial Register (CCMD-CTR) (all years to 11 Dec 2015). In addition we searched grey literature resources as well as the international trial registers ClinicalTrials.gov and ICTRP to 28 September 2018. We screened reference lists of included studies and contacted the first author of all in- cluded studies. Selection criteria: We included randomized (RCTs) and non-randomized controlled trials (NRCTs) in adults with formally diagnosed PDD, receiving pharmacological, psychological, or combined continuation and maintenance interventions. DOI: https://doi.org/10.1002/14651858.CD012855.pub2 Posted at the Zurich Open Repository and Archive, University of Zurich ZORA URL: https://doi.org/10.5167/uzh-201363 Journal Article Published Version Originally published at: Machmutow, Katja; Meister, R; Jansen, A; Kriston, L; Watzke, Birgit; Härter, M; Liebherz, Sarah (2019). Comparative effectiveness of continuation and maintenance treatments for persistent depressive disorder in adults. Cochrane Database of Systematic Reviews, 20(5):CD012855. DOI: https://doi.org/10.1002/14651858.CD012855.pub2 2 Cochrane Library Cochrane Database of Systematic Reviews Comparative effectiveness of continuation and maintenance treatments for persistent depressive disorder in adults (Review) Machmutow K, Meister R, Jansen A, Kriston L, Watzke B, Härter MC, Liebherz S Machmutow K, Meister R, Jansen A, Kriston L, Watzke B, Härter MC, Liebherz S. Comparative effectiveness of continuation and maintenance treatments for persistent depressive disorder in adults. Cochrane Database of Systematic Reviews 2019, Issue 5. Art. No.: CD012855. DOI: 10.1002/14651858.CD012855.pub2. www.cochranelibrary.com Comparative effectiveness of continuation and maintenance treatments for persistent depressive disorder in adults (Review) Copyright © 2019 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. Cochrane Trusted evidence. Informed decisions. Library Better health. Cochrane Database of Systematic Reviews T A B L E O F C O N T E N T S HEADER......................................................................................................................................................................................................... 1 ABSTRACT..................................................................................................................................................................................................... 1 PLAIN LANGUAGE SUMMARY....................................................................................................................................................................... 2 SUMMARY OF FINDINGS.............................................................................................................................................................................. 4 BACKGROUND.............................................................................................................................................................................................. 6 OBJECTIVES.................................................................................................................................................................................................. 7 METHODS..................................................................................................................................................................................................... 7 RESULTS........................................................................................................................................................................................................ 12 Figure 1.................................................................................................................................................................................................. 13 Figure 2.................................................................................................................................................................................................. 18 Figure 3.................................................................................................................................................................................................. 19 Figure 4.................................................................................................................................................................................................. 20 Figure 5.................................................................................................................................................................................................. 21 Figure 6.................................................................................................................................................................................................. 23 DISCUSSION.................................................................................................................................................................................................. 26 AUTHORS' CONCLUSIONS........................................................................................................................................................................... 32 ACKNOWLEDGEMENTS................................................................................................................................................................................ 33 REFERENCES................................................................................................................................................................................................ 34 CHARACTERISTICS OF STUDIES.................................................................................................................................................................. 41 DATA AND ANALYSES.................................................................................................................................................................................... 58 Analysis 1.1. Comparison 1 Pharmacological continuation and maintenance therapies versus placebo, Outcome 1 Relapse/ 59 recurrence.............................................................................................................................................................................................. Analysis 1.2. Comparison 1 Pharmacological continuation and maintenance therapies versus placebo, Outcome 2 Dropout due 59 to any reason......................................................................................................................................................................................... Analysis 1.3. Comparison 1 Pharmacological continuation and maintenance therapies versus placebo, Outcome 3 Depression 60 severity................................................................................................................................................................................................... Analysis 1.4. Comparison 1 Pharmacological continuation and maintenance therapies versus placebo, Outcome 4 SF-36 Social 60 Functioning score.................................................................................................................................................................................. Analysis 1.5. Comparison 1 Pharmacological