MAINTENANCE THERAPY FOR CHRONIC DEPRESSION - A CONTROLLED CLINICAL-TRIAL OF DESIPRAMINE

Background: Previous studies have shown the efficacy of antidepressant s in the treatment of chronic depression. We report the results of a l ong-term study comparing desipramine hydrochloride and placebo for mai ntenance therapy of remitted patients with chronic depression. Methods : Outpatients who met DSM-III-R diagnostic criteria for ''pure'' dysth ymia (n = 51), dysthymia with current major depression (''double depre ssion'') (n = 64), or chronic major depression (n = 14) were treated o n an open basis with desipramine. Full and partial remitters after 10 weeks entered a continuation phase of open treatment with desipramine for 16 weeks. Remitted patients then were randomized to continue desip ramine treatment or tapered to placebo treatment for a maintenance pha se of up to 2 years. Relapse rates and time to relapse during maintena nce therapy were compared between the two treatment groups. Results: A cute-phase treatment results did not differ significantly according to chronic depression subtype. Remission persisted with a high degree of stability during the continuation phase. Relapse rates during the mai ntenance phase were 52% for the placebo group and 11% for the active d esipramine group (chi(2) = 8.1, P = .004). Most placebo relapses occur red during the first 6 months of maintenance therapy. Active medicatio n was significantly more effective than placebo in that subgroup enter ing the maintenance phase in full remission and in those patients who fulfilled criteria for a diagnosis of pure dysthymia or double depress ion on entry to the study. Conclusion: Long-term maintenance treatment with desipramine appeared to be effective in the prevention or postpo nement of relapse of depression in patients who responded to desiprami ne during the acute and continuation phases.