LONG-TERM DRUG-TREATMENT OF UNIPOLAR DEPRESSION

Depression is characterized by a recurrent course in many patients, an d as a potentially chronic illness. It therefore often requires a long -term treatment strategy. This article proposes pragmatic answers to t he questions involved in devising such a strategy, using the available literature. Cessation of treatment immediately after the observation of a response is associated with a high relapse rate, especially withi n the following 4 months, and all patients should therefore be treated for at least 3-6 months after the acute response to secure a stable r emission. Patients at risk of recurrence should be considered for main tenance therapy thereafter. Such patients include those with prior epi sodes of depression within the last 5 years, those with a particularly severe or chronic depressive episode, those with residual symptoms sc oring HAMD > 8 and also those whose age at onset was < 25 or < 60 year s. Those who need maintenance therapy are likely to need it fora numbe r of years, or indefinitely. SSRIs are better tolerated than TCAs or M AOIs and display similar efficacy in acute, continuation and maintenan ce treatment. They are less likely to be fatally toxic if taken in ove rdosage. There is growing evidence to support the use of a full therap eutic dose of antidepressant in maintenance treatment.