Meta-Analysis: relapse prevention strategies for depression and anxiety in remitted adolescents and young adults

OBJECTIVE: Depression and anxiety cause a high burden of disease and have high relapse rates (39-72%). In this meta-analysis, we systematically examined effectiveness of relapse prevention strategies on risk of and time to relapse in youth who remitted.

METHOD: PubMed, PsycInfo, Embase, Cochrane and Eric were searched up to June 15 2021. Eligible studies compared relapse prevention strategies to control conditions among youth who were previously depressed or anxious, or youth with >30% improvement in symptomatology (mean age 13-25 years). Two reviewers independently assessed titles, abstracts, full-texts, extracted study data, assessed risk of bias, and overall strength of evidence. Random-effects models were used to pool results, and mixed-effects models for subgroup analyses. Main outcome was relapse rate at last follow-up (PROSPERO-ID: CRD42020149326).

RESULTS: Ten randomized controlled trials (RCTs) examined depression, including 9 eligible for analysis: 4 included psychological interventions (n=370), 3 antidepressants (n=80), and 2 combinations (n=132). No RCTs for anxiety were identified. Over 6 to 75 months, relapse was half as likely following psychological treatment compared to CAU conditions (k=6; OR 0.56, 95%-CI 0.31-1.00). Sensitivity analyses including only studies with >50 participants (k=3), showed similar results. Over 6 to 12 months, relapse was less likely in antidepressants compared to pill placebo (k=3; OR 0.29, 95%-CI 0.10-0.82). Quality of studies was suboptimal.

CONCLUSION: Relapse prevention strategies for youth depression reduce risk of relapse, although adequately powered, high quality RCTs are needed. This finding, together with the lack of RCTs on anxiety, underscores the need to examine relapse prevention in youth facing these common mental health conditions.