Clinical issues in long-term treatment with antidepressants

Historically, the emphasis in treating depression has been focused on the a cute: phase of treatment. with few published data on the continuation and m aintenance phases of treatment. Yet the risk of depression includes with ea ch episode, with a 50% to 90% chance of developing another episode after 1 or 2 prior episodes of depression. Moreover, subsequent episodes of depress ion are often of longer duration, more severe, and less responsive to treat ment. Most patients with major depression require some form of long-term an tidepressant treatment, and many need lifelong treatment. Optimizing effica cy and minimizing side effects are essential during both the acute and long -term phases of antidepressant treatment. Antidepressant side effects, incl uding insomnia or somnolence, weight gain, asthenia, and sexual dysfunction , can significantly decrease patient compliance with long-term treatment fo r depression. Identification and management of side effects, combined with early and ongoing educational messages to the patient about treatment issue s and the importance of sustaining illness remission, help improve complian ce and reduce the potential for premature discontinuation of an otherwise o ptimal antidepressant.