Section - Quick Takes

02. Antidepressants for the Treatment of Adults with Major Depressive Disorder in the Maintenance Phase: A Systematic Review and Network Meta-Analysis

Published on March 1, 2023 Certification expiration date: March 1, 2029

James Phelps, M.D.

Research Editor - Psychopharmacology Institute

Key Points

The latest “randomized discontinuation” study of long-term antidepressant use, published in the New England Journal of Medicine, supports the old 3 strikes rule: After a third episode of depression, patients who’ve responded well to an antidepressant for the first 2 episodes should stay on an antidepressant “indefinitely.”
But the randomized discontinuation design itself has been questioned, based on new (and old) data regarding the prevalence of withdrawal symptoms that look like depression and thus confound the interpretation of apparent “relapse.”

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You’ve probably heard of the 3 strikes rule for depression. The first time a patient goes on an antidepressant and it works, they can try tapering off after 6 months or so. If they later become depressed again and go back on and recover, they can try tapering again perhaps after a longer period of time. But if they have a third episode of depression and recover on an antidepressant again, the 3 strikes rule says they should stay on that antidepressant indefinitely. This Quick Take was supposed to cover a new network meta-analysis of studies with data regarding this rule—that is, regarding whether patients with several relapses into depression when their antidepressant is stopped should just stay on it. But recent articles suggest that we should question the very design of this research, calling into question all prior results.

Hi! Jim Phelps here for the Psychopharmacology Institute. This is

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03. Augmentation Strategies for Clozapine Resistance: A Systematic Review and Meta-Analysis

Learning Objectives:

Examine whether baseline cognitive function is a predictor of illness course in first-episode schizophrenia.
Evaluate the research basis for the “3 strikes rule” of antidepressant treatment for recurrent depression.
Discuss the evidence base regarding the efficacy of mirtazapine as an adjunctive agent for the management of clozapine-resistant schizophrenia.
Examine whether C-reactive protein can be a clinically useful predictor of antidepressant response.
Evaluate the efficacy of extract of lavender for the treatment of insomnia.

Original Release Date: March 1, 2023

Review and Re-release Date: March 1, 2026

Expiration Date: March 1, 2029

Expert: James Phelps, M.D.

Medical Editor: Melissa Mariano, M.D.

Relevant Financial Disclosures:

James R Phelps declares the following interests:

– McGraw-Hill: Royalties

– W.W. Norton & Co.: Royalties

All of the relevant financial relationships listed above have been mitigated by Medical Academy and the Psychopharmacology Institute.

Contact Information: For questions regarding the content or access to this activity, contact us at support@psychopharmacologyinstitute.com

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This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through the joint providership of Medical Academy LLC and the Psychopharmacology Institute. Medical Academy is accredited by the ACCME to provide continuing medical education for physicians.

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Medical Academy designates this enduring activity for a maximum of 0.5 AMA PRA Category 1 credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.