Stable remission of depression after antidepressant treatment: prevalence and related sociodemographic and clinical characteristics in a longitudinal, real-world cohort

There is considerable variability in how patients respond to antidepressants. Currently, rates of sustained symptomatic remission (i.e. stable remission) and factors associated with stable remission are unclear. Here, we study onset of stable remission and its associated sociodemographic and clinical factors in patients with depression who recently started antidepressant medication. Data were obtained from the observational, naturalistic OPERA-monitor out-patient cohort, including 591 adults with depression who started citalopram or sertraline within the past six months. Between June 2019 to January 2024, participants completed surveys every two months for up to 24 months. Multivariable Cox proportional hazard models were used to identify factors associated with onset of stable remission, defined as 1) two subsequent Inventory of Depressive Symptomatology Self Report (IDS SR) scores ≤21, and 2) six-month absence of major depressive disorder (Simplified Mini-International Neuropsychiatric Interview). Over a median follow-up duration of 0.87 years, 278 (47 %) out of 591 participants reached stable remission (0.46 events per person-year), of which 183 did so within one year after starting antidepressants. Higher antidepressant dose (hazard ratio (HR) 0.73; 95 % confidence interval (CI) 0.57–0.94), and higher IDS depression score (HR 0.94; 95 %CI 0.93–0.96) were independently associated with a lower likelihood of stable remission. Nearly half of patients starting antidepressant medication reached stable remission. Higher depressive symptoms and higher dose – both likely reflecting more severe depression – were associated with lower remission rates. Findings highlight the need to identify and address factors hindering stable remission. • Considerable variability exists in patient response to antidepressant treatment • We examined onset of stable remission in patients starting citalopram or sertraline • Nearly half of patients had stable remission during a median follow-up of 0.87 year • Higher depression severity and dose were linked to a lower risk of remission • Results highlight the need for further optimization of depression treatment