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Long term pharmacotherapy of depression

BMJ 1998; 316 doi: (Published 18 April 1998) Cite this as: BMJ 1998;316:1180

Can reduce relapses and recurrences in major depression

  1. J Guy Edwards, Honorary clinical senior lecturer
  1. University of Southampton, Faculty of Medicine, Health and Biological Sciences, Department of Psychiatry, Royal South Hants Hospital, Southampton S014 OYG

    The high rates of persistent morbidity, recurrence, and death among patients treated for depression 1-2 have highlighted the importance of long term psychological and pharmacological treatment. What evidence do we have that long term drug treatment is effective, and how should we choose between individual drugs?

    Long term drug treatment comprises continuation and maintenance treatment. Continuation treatment helps to consolidate recovery from depressive episodes and prevent relapses (worsening of continuing or recently treated episodes). Maintenance or prophylactic treatment helps to prevent occurrence of new episodes and is usually recommended for patients who have had at least three depressive episodes in the preceding five years. The distinction between continuation and maintenance treatment is somewhat arbitrary and may not reflect underlying biological processes, but most researchers agree that four to six months' remission should occur before a recurrence is diagnosed.

    Differences in methods between the many trials of long term pharmacological treatment make interpretation difficult, but about 60% of patients who respond to an antidepressant and are then given a placebo remain in remission for …

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