{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T11:38:01Z","timestamp":1785411481879,"version":"3.56.0"},"posted":{"date-parts":[[2026,7,20]]},"group-title":"Psychiatry and Clinical Psychology","reference-count":35,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T00:00:00Z","timestamp":1784505600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"award":["T15LM007092"],"award-info":[{"award-number":["T15LM007092"]}],"id":[{"id":"https:\/\/ror.org\/01cwqze88","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,7,20]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Importance<\/jats:title>\n                  <jats:p>Patients who achieve remission from major depressive disorder (MDD) often face a preference-sensitive decision between continued antidepressant maintenance and discontinuation with active monitoring. Quantifying the tradeoff between depression burden and long-term medication exposure may support more individualized shared decision-making.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To quantify tradeoffs between continuous antidepressant maintenance and active monitoring after MDD remission, and to identify preference thresholds favoring each strategy across relapse-risk strata.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>Individual-level decision-analytic health-state transition model calibrated to randomized maintenance-discontinuation trials and a longitudinal first depressive episode cohort, with a 5-year time horizon.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>Outpatient clinical decision after completion of an 8-month continuation phase following remission from MDD.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Participants<\/jats:title>\n                  <jats:p>Adults in remission from MDD, represented across 4 clinically anchored relapse-risk strata ranging from very low risk after a first mild episode to high risk after highly recurrent depression.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Exposures<\/jats:title>\n                  <jats:p>Continuous antidepressant maintenance vs discontinuation with active monitoring and antidepressant restart after detected relapse.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Main Outcomes and Measures<\/jats:title>\n                  <jats:p>Severity-weighted depression-months, antidepressant medication-years, medication-years per depression-month averted, and net benefit across preference thresholds defined as the maximum additional medication-years a patient would be willing to accept to avert 1 depression-month.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Continuous maintenance reduced depression burden but required substantially more medication exposure, with efficiency strongly dependent on relapse risk. Medication-years per depression-month averted ranged from 11.8 (95% uncertainty interval [UI], 7.8-19.6) in the very low-risk group to 1.5 (95% UI, 0.8-3.0) in the high-risk group. At a preference threshold of 3 medication-years per depression-month averted, maintenance was preferred for moderate- and high-risk patients; at a threshold of 2, only for high-risk patients; and at a threshold of 1, for no risk group.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusions and Relevance<\/jats:title>\n                  <jats:p>In this decision-analytic model, the value of continuous antidepressant maintenance depended strongly on baseline relapse risk and patient preferences regarding long-term medication exposure. These findings provide a quantitative framework for shared decision-making about antidepressant maintenance after remission from MDD.<\/jats:p>\n                <\/jats:sec>","DOI":"10.64898\/2026.07.17.26358340","type":"posted-content","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T23:30:17Z","timestamp":1784590217000},"source":"Crossref","is-referenced-by-count":0,"title":["Antidepressant Maintenance Versus Active Monitoring After Depression Remission: A Decision Analysis Stratified by Relapse Risk and Patient Preferences"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1757-1451","authenticated-orcid":false,"given":"William U.","family":"Meyerson","sequence":"first","affiliation":[{"name":"Center for Precision Psychiatry, Massachusetts General Hospital, Boston, Massachusetts"},{"name":"Department of Psychiatry, Massachusetts General Hospital\/Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5379-2502","authenticated-orcid":false,"given":"Tianxi","family":"Cai","sequence":"additional","affiliation":[{"name":"Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts"},{"name":"Department of Biostatistics, Harvard T.H. 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