Impact of the Long-Term Adherence to Antidepressants on Relapse Rate: Systematic Review

Abstract

This systematic review of of 13 studies examines the impact of long-term adherence to antidepressants on relapse rates in adults with major depressive disorder (MDD). The findings consistently demonstrate that sustained antidepressant use significantly reduces relapse risk compared to discontinuation or short-term treatment. Pooled data from randomized controlled trials (RCTs) revealed relapse rates of 18% for maintenance therapy versus 41% for placebo, while observational studies reported hazard ratios as low as 0.42 for adherent patients, indicating a 58% lower relapse risk. However, adherence remains suboptimal, with only one-third of patients continuing treatment beyond six months due to side effects, stigma, and inadequate follow-up.

This review highlighted the protective effects of long-term adherence, with higher relapse rates for maintained medication compared to thhose for discontinued use. The review also identified the synergistic benefits of combining antidepressants with psychotherapy, where cognitive behavioral therapy (CBT) reduced relapse in discontinuation groups.

The review underscores the need for standardized metrics, integrated care models, and targeted interventions to improve adherence. Clinical implications emphasize patient education, shared decision-making, and proactive monitoring to sustain long-term treatment. Future research should explore extended follow-ups, marginalized populations, and the optimal duration of maintenance therapy to refine depression management strategies.