LONG-TERM MANAGEMENT OF DEPRESSION

Major depression is often a chronic and recurrent disorder. Findings f rom a landmark study, the Pittsburgh Study of Maintenance Therapies in Recurrent Depression, demonstrate that full doses of antidepressants prevent recurrent depression and that maintenance therapy lasting at l east 5 years may be required for patients with severely recurrent dise ase. Ln addition, psychotherapy is a useful adjunct to antidepressant maintenance therapy in prolonging the duration between recurrent episo des. The currently accepted approach to preventing recurrent depressio n is to treat the acute episode to full remission and follow up by mai ntaining the patient on the full, acute dose used to achieve the initi al response. The selective serotonin reuptake inhibitors (SSRIs) have been studied in recurrent depression and are rational choices for init ial maintenance therapy because of demonstrated efficacy, safety, and tolerance during long-term therapy.