Will a second prophylactic treatment with a higher dosage of the same antidepressant either prevent or delay new depressive episodes?

Fifty-seven highly recurrent unipolar patients, excluded from previous long -term studies with selective serotonin reuptake inhibitors (SSRIs) after th ey experienced a new recurrence, were acutely treated with the full dosage of the SSRIs they were on. Fifty-one of them (89.5%) had a sustained respon se and entered into the 4-month continuation therapy. During this phase, no relapse was observed. At the end of it, all patients gave their written in formed consent to be enrolled in a 24-month long-term therapy, maintaining the same treatment dosage of fluvoxamine 300 mg/day, sertraline 150 mg/day, or paroxetine 40 mg/day. At the end of the study, 28 out of the 51 outpati ents (54.9%) showed a further recurrence. Nevertheless, second recurrences observed during this second maintenance therapy were less severe than first recurrences, decreasing from 25.1 +/- 3.4 to 21.6 +/- 3.3 (P < 0.0001), re spectively. Considering the clinical characteristics of patients, we found that a high number of prior depressive episodes and an early age at onset o f illness may predict a bad outcome. Moreover, patients with a longer durat ion of euthymia during a first maintenance period are less likely to have a new episode of depression. (C) 2000 Elsevier Science Ireland Ltd. All righ ts reserved.