In Depression, Residual Symptoms May Signal Relapse

The presence of comorbid dysthymia and residual symptoms of depression, including insomnia and irritability, following a course of acute treatment may predict relapse among youth with major depressive disorder (MDD), results of a new study show.

From June 2000 to October 2005, the researchers evaluated 102 youth participants aged 7 to 18 years with MDD who had responded to 12 weeks of fluoxetine treatment during the acute phase of the trial.
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A multiple logistic regression model was used to assess potential predictors and moderators of relapse, as well as the effects of 12-week continuation treatment on relapse status at week 24.

According to study findings, girls who remained on fluoxetine for the duration of continuation treatment had a 9-fold higher risk of relapse than boys (adjusted OR 8.86).

Factors associated with an increased risk of relapse in all participants included comorbid dysthymia (adjusted odds ratio [OR] 2.88), low levels of family leadership (adjusted OR 1.39), and higher levels of depressive symptoms after remaining on fluoxetine for continuation treatment.

Higher levels of depression (OR 1.21), insomnia (OR 6.74), and irritability (OR 7.40) at the end of 12-week acute treatment were also associated with an increased risk of relapse.

“This is the first large continuation study for treatment of depression in youth to examine predictors and moderators of relapse,” the researchers wrote. “Youth with greater improvement by the end of 3 months of treatment were less likely to relapse than those with continued depressive symptoms.

“In addition, youth with comorbid dysthymia had 3 times greater risk of relapse that those without,” they added. “Targeting residual symptoms, particularly sleep disturbance and irritability, earlier in treatment may reduce relapse rates.”

—Christina Vogt

Reference:

Kennard BD, Mayes TL, Nakonezny PA, Moorehead A, Emslie GJ. Predictors and moderators of relapse in children and adolescents with major depressive disorder. J Clin Psychiatry. 2018;79(2). doi:10.4088/JCP.15m10330.