Depressive breakthrough

Patients with major depression tend to have multiple episodes. Episodes tha t redevelop within 6 months of acute response are called relapses, whereas those that occur after 6 months are called recurrences.(17) Theoretically, relapses are considered a return of the original episode, whereas recurrenc es represent a new episode; but these are hypotheses without any substantia ting data. Without long-term antidepressant treatment, depressive relapses or recurrences occur in 50% to 80% of patients.(11,17,23,26,38) Double-blin d, discontinuation studies reveal that antidepressants decrease the risk fo r relapse and recurrence and have repeatedly been shown antidepressants to be more efficacious than placebo substitution.(11,16,30,42,48) Nonetheless, observational studies have shown that, within 1 to 5 years after an acute response, 20% to 80% of patients develop another depressive episode even wh ile taking longterm antidepressants for prophylaxis.(27,30,36,40) A succinc t term for relapse or recurrence during long-term antidepressant treatment is depressive breakthrough. Several case series and only a few controlled studies have described the re turn of major depression during: long-term antidepressant therapy, but fewe r studies have examined the management of patients who have depressive brea kthrough. With increasing emphasis on long-term treatment of chronic relaps ing and recurring depressive disorders, and the dramatic increase in the nu mber of patients who use selective serotonin reuptake inhibitor (SSRI) anti depressant therapy within the past 5 years, the treatment of depressive bre akthrough must be improved.