METHODOLOGICAL APPROACHES TO THE LONG-TERM STUDY OF ANTIDEPRESSANTS

It has long been known that most patients with bipolar disorder have a course marked by multiple recurrence of major depressive and manic ep isodes. More recently, many epidemiological studies have shown that at least 50% of unipolar depressive patients have one or more subsequent episodes of depression in their lifetimes. Likewise, relapse followin g successful short-term treatment of depression is so common that it i s now recommended to prolong treatment in the form of maintenance phar macotherapy. Interest in preventing the recurrence of depression has b een stimulated by the results from long-term trials involving antidepr essant drugs and lithium. However, these pharmacological studies suffe r somewhat from methodological deficits, making difficult any clear an d complete interpretation of their results. While some methodological recommendations have now been established to compensate for previous d eficits (eg, definition of relapse and recurrence, duration of acute a nd maintenance treatments, statistical analysis of efficacy), unfortun ately, many key points still remain to be resolved (eg, selection of p atients, dosage in maintenance and prophylactic phases, maximum length of a course of treatment, etc).