Factors affecting return of symptoms 1 year after treatment in a 62-week controlled study of fluoxetine in major depression

Background: In spite of impressive results in acute studies, the long-term treatment of major depression remains problematic. To explore the return of depressive symptoms and their interaction with social factors on long-term outcome, we assessed 55 patients whose depression had been treated during a 62-week, fluoxetine maintenance study, 1 year after the study's terminati on. Method: During the year following the study termination, patients were free to select treatment options. Assessments at the 1-year follow-up inclu ded measures of depressive symptoms (using the Hamilton Rating Scale for De pression [HAM-D]), social and marital impairment (using the Weissman Social Adjustment Scale [SAS]), personal stressors (using the Holmes Social Readj ustment Rating Scale), and history of treatment during the past year. Resul ts: At the time of the naturalistic follow-up, 53% of patients sustained th eir improvement in mood. Factors associated with return of depressive sympt oms included personal stresses, marital maladjustment, personal decision to discontinue antidepressants, and medication failure. Psychosocial variable s were associated with poor outcome in over 90% of impaired subjects. Devel opment of subsyndromal symptoms during the 50-week double-blind phase was p redictive of poorer outcome at the long-term follow-up. Conclusion: The stu dy demonstrates that no matter how effective initial pharmacologic therapy may be, without ongoing clinical monitoring and support, particularly in de aling with issues such as marriage and handling significant life stresses, and compliance with medications, it will not be successful in the long-term treatment for a significant portion of patients with depression.