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Three-Year long-term outcome of 458 naturalistically treated inpatients with major depressive episode: severe relapse rates and risk factors

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Abstract

In randomized controlled trials, maintenance treatment for relapse prevention has been proven to be efficacious in patients responding in acute treatment, its efficacy in long-term outcome in “real-world patients” has yet to be proven. Three-year long-term data from a large naturalistic multisite follow-up were presented. Severe relapse was defined as suicide, severe suicide attempt, or rehospitalization. Next to relapse rates, possible risk factors including antidepressant medication were identified using univariate generalized log-rank tests and multivariate Cox proportional hazards model for time to severe relapse. Overall data of 458 patients were available for analysis. Of all patients, 155 (33.6 %) experienced at least one severe relapse during the 3-year follow-up. The following variables were associated with a shorter time to a severe relapse in univariate and multivariate analyses: multiple hospitalizations, presence of avoidant personality disorder, continuing antipsychotic medication, and no further antidepressant treatment. In comparison with other studies, the observed rate of severe relapse during 3-year period is rather low. This is one of the first reports demonstrating a beneficial effect of long-term antidepressant medication on severe relapse rates in naturalistic patients. Concomitant antipsychotic medication may be a proxy marker for treatment resistant and psychotic depression.

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Acknowledgments

The study was performed within the framework of the German Research Network on Depression, which was funded by the German Federal Ministry for Education and Research BMBF (01GI0219). The BMBF had no further role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.

Conflict of interest

All other authors declare that they have no conflicts of interest.

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Authors and Affiliations

  1. Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Nussbaumstrasse 7, 80336, Munich, Germany

    Florian Seemüller, Sebastian Meier, Michael Obermeier, Richard Musil, Michael Riedel, Peter Falkai & Hans-Jürgen Möller

  2. Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Dresden, Technical University Dresden, Fetscherstr. 74, 01307, Dresden, Germany

    Michael Bauer

  3. Department of Psychiatry and Psychotherapy, Campus, Charité Mitte (CCM), Charitéplatz 1, 10117, Berlin, Germany

    Mazda Adli

  4. Department of Psychiatry and Psychotherapy, University of Heidelberg, Voßstr. 2, 69115, Heidelberg, Germany

    Klaus Kronmüller

  5. Department of Psychiatry and Psychotherapy, Max Planck Institute of Psychiatry, Kraepelinstr. 2-7, 80804, Munich, Germany

    Florian Holsboer

  6. Department of Psychiatry and Psychotherapy, Martin-Luther University Halle-Wittenberg, Julius-Kühn-Str. 7, 06097, Halle, Germany

    Peter Brieger

  7. Department of Psychiatry and Psychotherapy, Inn-Salzach-Klinikum, Gabersee 7, 83512, Wasserburg, Germany

    Gerd Laux

  8. Department of Psychiatry and Psychotherapy, Isar-Amper-Klinikum Munich East, Vockestr. 72, 85540, Haar, Germany

    Wolfram Bender

  9. Department of Psychiatry and Psychotherapy, Campus Charité Benjamin Franklin (CFB), Eschenallee 3, 14050, Berlin, Germany

    Isabella Heuser

  10. Department of Psychiatry and Psychotherapy, Auguste-Viktoria-Krankenhaus, Rubensstr. 125, 12157, Berlin, Germany

    Joachim Zeiler

  11. Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Bergische Landstr. 2, 40629, Duesseldorf, Germany

    Wolfgang Gaebel

  12. Department of Psychiatry and Psychotherapy, Vinzenz von Paul Hospital, Rottweil, Germany

    Michael Riedel

  13. Department of Psychiatry and Psychotherapy, kbo-Lech-Mangfall-Klinik, Garmisch-Partenkirchen, Germany

    Florian Seemüller

Authors
  1. Florian Seemüller
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  2. Sebastian Meier
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  3. Michael Obermeier
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  4. Richard Musil
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  5. Michael Bauer
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  6. Mazda Adli
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  7. Klaus Kronmüller
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  8. Florian Holsboer
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  9. Peter Brieger
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  10. Gerd Laux
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  11. Wolfram Bender
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  12. Isabella Heuser
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  13. Joachim Zeiler
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  14. Wolfgang Gaebel
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  15. Michael Riedel
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  16. Peter Falkai
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  17. Hans-Jürgen Möller
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Corresponding author

Correspondence to Florian Seemüller.

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Seemüller, F., Meier, S., Obermeier, M. et al. Three-Year long-term outcome of 458 naturalistically treated inpatients with major depressive episode: severe relapse rates and risk factors. Eur Arch Psychiatry Clin Neurosci 264, 567–575 (2014). https://doi.org/10.1007/s00406-014-0495-7

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  • DOI: https://doi.org/10.1007/s00406-014-0495-7

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