Neurocognitive predictors of depression relapse

The burden of depression is in no small part due to its chronic or recurring nature. As such, the maintenance of any treatment gains is of paramount importance. A key step in this process is the decision to discontinue antidepressant medication. However, at present there are no predictors to indicate who can safely discontinue medication. The AIDA study recruited 123 patients who had remitted on antidepressant medication and were intent on discontinuing their medication. Patients were randomized into two groups. Both groups underwent two extensive assessments involving clinical, behavioural, imaging and biochemical assessments, but one group was tested before and after discontinuing antidepressants, while the other was tested twice before discontinuation. Patients were followed up for 6 months to monitor for relapses.
57 healthy, never-depressed matched controls were recruited. Of 104 patients who completed at least one assessment, 84 completed the study, with 34 relapsing during the follow-up. Amongst standard clinical variables, only treatment by non-specialists was robustly associated with relapse (p=0.005), but did not predict relapse out-of-sample. In contrast, several behavioural (effort-related), psychological (brooding rumination, neuroticism) and imaging (EEG alpha asymmetry) variables had predictive power, while others were affected by discontinuation or distinguished remitted patients from healthy controls.
Relapse after antidepressant discontinuation can be predicted by a number of variables. A combination of these may reach an accuracy sufficient to guide clinical decision-making.