ADEPP investigates whether the antidepressant sertraline could prevent depression and support recovery in people following their first episode of psychosis.

Summary of the project and objectives

The Antidepressant for the Prevention of Depression following First Episode Psychosis trial (ADEPP) investigated whether the antidepressant sertraline could prevent depression in people recovering from their first episode of psychosis.

The study aimed to establish whether taking sertraline for six months could reduce the likelihood of developing depression, support recovery and reduce the risk of relapse and suicidal thoughts. It also assessed whether this approach represented a cost-effective treatment for the NHS.

Why the project is important

Around 40% of people who experience a first episode of psychosis subsequently develop depression. This can make it more difficult for people to return to education, employment, relationships and other aspects of everyday life. Depression following psychosis is also associated with poorer recovery, anxiety, suicidal thoughts and an increased risk of experiencing another psychotic episode.

Although antidepressants are used to treat depression in people with established schizophrenia, it was not known whether starting an antidepressant earlier could prevent depression from developing following a first episode of psychosis. ADEPP aimed to provide the evidence needed to inform future clinical guidance and treatment.

How we planned to achieve this

ADEPP was a randomised, double-blind, placebo-controlled clinical trial involving people receiving support from Early Intervention in Psychosis services.

Participants were randomly allocated to receive either sertraline or a placebo once a day for six months. Neither the participants nor the research teams knew which treatment each participant was receiving during the trial. Researchers compared the proportion of participants who developed depression in each group and examined wider effects on recovery, symptoms, relapse and quality of life.

Additional recruitment centres in Greater Manchester and the East Midlands helped the study include people from areas with high levels of deprivation and diverse ethnic communities, which have historically been underrepresented in mental health research.

Funding source

ADEPP was funded by the National Institute for Health and Care Research Health Technology Assessment programme (NIHR HTA).

Who supported the project

The study was led by the University of Birmingham and delivered through Early Intervention in Psychosis services and NHS research teams across several regions of the UK.

The expanded recruitment work was supported by:

• Greater Manchester Mental Health NHS Foundation Trust
• Pennine Care NHS Foundation Trust
• Nottinghamshire Healthcare NHS Foundation Trust
• Participating services and research teams in the West Midlands, Lancashire, Coventry and Wales

Researchers, clinicians and research assistants worked closely with local Early Intervention in Psychosis teams to make participation accessible to people recovering from a first episode of psychosis.

Further information online

ADEPP - University of Birmingham

For more information please contact:

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