More than 80% of all patients suffering from depression are currently managed by primary health care and drug therapy is the first-line treatment. Primary health care services are the ideal setting for carrying out recurrence prevention strategies. Therefore, there is insufficient knowledge on the association between the different classes and combinations of psychoactive drugs and the occurrence of such relapses and recurrences. Only a few meta-analyses include studies of specific drugs versus placebo, obtaining inconclusive conclusions. To our knowledge, no studies have analyzed the relationship between antidepressant pharmacologic strategies and depression recurrence. Īlthough many studies have compared the effectiveness of specific antidepressant therapy drugs and have assessed relapses, there is little scientific evidence regarding the relationship between pharmacologic treatments and recurrence. Īs for drug therapy, interruption of antidepressant treatment when in remission from the depressive episode leads to a risk of recurrence in 40–50% of the patients, whereas maintaining the treatment for 6 to 12 months after remission reduces this risk to 13–20%.

Previous bibliographies have highlighted certain factors involved in the recurrence of depression, such as the severity of major depression episodes (MDE) the number of depressive episodes experienced, early age of onset of first MDE, comorbidity with axis I and axis II psychiatric pathology change in the size of specific brain areas immunologic irregularities history of suicide attempts family history of depression concurrent physical health problems and psychosocial difficulties stressful live events, and female gender and older age. Subsequently, mean time of recurrence progressively decreases, and length of recovery increases in a study performed on a Dutch population, patients suffering from major depression who recovered presented a cumulative recurrence range of 13% in 5 years, 23% in 10 years and 42% in 20 years, respectively. Recurrence risk is higher during the initial months following recovery. The mean time of the recurrence following the initial episode is approximately three years, and subsequent episodes usually appear after 1 or 1.5 years. Individuals suffering from an initial depressive episode have a 40% to 60% chance of experiencing a subsequent episode individuals with 2 episodes have approximately 60% to 70% possibility and for individuals experiencing three episodes, the risk is up to 90%. Relapse suggests the reemergence of depression symptoms (presumably part of the depressive episode) following some degree of remission but preceding recovery and recurrence implies the onset of a new depression episode following an extended period of remission, sufficiently long so as to assume that recovery had taken place. According to these criteria, remission occurs when symptoms have largely normalized and the patient can be considered well for a given period of time (often defined as two months or longer), and precedes both recovery and recurrence. The ‘MacArthur Research Network on the Psychobiology of Depression’ proposed operational criteria for the constructs of response, remission, recovery, relapse and recurrence as guidance for the field. Major depressive disorder (MDD) is highly recurrent, making the prevention of depressive relapse and recurrence depression one of the most important challenges to its management. This mental health problem is often a medium- and long-term condition, having a high comorbidity rate. It is also the most expensive mental disorder, accounting for 1% of the Gross Domestic Product (GDP) of the European Union.

Women typically have a two-fold increased risk of major depression as compared to men, and the peak age of risk for the first onset of a major depressive episode (including bipolar depression) is estimated to range from mid-late adolescence to the early 40s. Depression is one of the most prevalent health problems in primary care, and is one of the four medical conditions causing the largest number of disabilities.

Major depressive episode length