Delay Discounting Fails to Predict MDD Relapse, Q&A With Giles Story, PhD

Delay discounting did not predict relapse after antidepressant discontinuation in patients with remitted major depressive disorder (MDD), despite a modest association with residual depressive symptoms, new data show.1,2,3

In an interview with HCPLive, Giles W. Story, PhD, of University College London, noted that the findings highlight the lack of reliable tools for predicting MDD relapse and emphasize the importance of individualized, shared decision-making when counseling patients.

The multi-site longitudinal study, led by Story and Doron Elad, PhD, of Technion-Israel Institute of Technology, enrolled 97 patients with remitted MDD receiving antidepressants and 54 matched healthy controls across Zurich and Berlin, with participants completing validated delay discounting tasks at baseline and after randomization to continuation or discontinuation. During the 6-month follow-up, 35% of patients relapsed. Patients with remitted MDD showed steeper baseline delay discounting than controls (Cohen’s d = 0.34), and a modest link to subthreshold depressive symptoms, but neither baseline discounting nor post-discontinuation changes predicted relapse.

During the interview, Story also addressed study limitations, including the relatively short follow-up period for a chronic, relapsing illness, and suggested future research may benefit from examining more dynamic, stress-responsive behavioral markers rather than relying on static, single-time-point measures.

HCPLive: What should clinicians take away from the study when counseling patients who are considering continuing antidepressant medication?

Story: The decision to stop or come to the new antidepressant is a difficult one. It's one that has to be made on an individual basis, and [in] discussion with the clinician. In some ways, our study contributes to the uncertainty around that decision.

We know…that continuing an antidepressant actually reduces your risk of relapse. Amongst people…that stop [a] antidepressant, around 40% of those will go on to relapse. Those [who] continue it, around 20%...relapse. We know that [taking] an antidepressant reduces the risk of relapse, but this needs to be weighed against side effects and tolerability.

And of course, because we don't know for any given person whether or not stopping the medication is going to be the thing that makes the difference. It’s something that has to be thought about in context…where that person is in their life, or other treatment options. They might have [to] start some talking therapy…My advice would be that's something to think through and communicate with [a] clinician.

HCPLive: Can you discuss the limitations of the study?

Story: It was a fairly short follow-up time. Patients were followed up for 6 months… whereas depression is a chronic illness that can relapse over some years. It may be that if you had a very long follow-up, you'd start to fix some of these effects. That said, we had a reasonable number relapsing even in [a] not short time.

There was some dropout. Some people were lost [to] follow up, [which could] potentially… mean we missed an effect. Let's say, for example, that more impulsive people were more likely to relapse and they're more likely to drop out. That might mean that we can miss [a] bunch of important signals.

HCPLive: Were there any subgroups in whom delay discounting may still have clinical relevance?

Story: In this particular study, we didn't do much on the way of subgroup analysis, but we do know from other work that discounting is quite strongly associated with addiction dependence.

This is an area where discounting can have some migrants. [It] is probably the strongest of all clinical syndromes that are linked to discounting. And there’s actually some evidence of prospective prediction as well. For example…a study that measured people's discounting as they went into a bar…found that people [who] were more impatient for reward as they were entering the bar became more drunk than higher blood patients.

HCPLive: How might future studies build on this work to identify more reliable behavior or cognitive prediction predictors of relapse?

Story: I think we need to move to more dynamic forms of prediction. Relapse is a complex thing and depends on that interaction between a person, their social world, and the outside world. It might be more fruitful to start to look at stress test markers. For example…how somebody's discounting changed in response to a change in their circumstances might be more powerful than discounting as a standalone.

References

1. Elad D, Story GW, Berwian IM, Stephan KE, Walter H, Huys QJM. Delay discounting correlates with depression but does not predict relapse after antidepressant discontinuation. Mol Psychiatry. Published online January 8, 2026. doi:10.1038/s41380-025-03402-5

2. Story G. Delay Discounting vs Traditional Predictors of MDD Relapse, With Giles Story, PhD. HCPLive. Published on February 1, 2026. Accessed on February 4, 2026. https://www.hcplive.com/view/delay-discounting-vs-traditional-predictors-mdd-relapse-giles-story-phd

3. Story G. Delay Discounting Offers No Predictive Value for MDD Relapse, With Giles Story, PhD. HCPLive. Published on February 4, 2026. Accessed on February 4, 2026. https://www.hcplive.com/view/delay-discounting-offers-no-predictive-value-mdd-relapse-giles-story-phd