Pharmacotherapy to sustain the fully remitted state

Full remission should be the goal of antidepressant therapy; anything less leaves the patient with residual symptoms and an increased risk of relapse and recurrence. Most antidepressant agents offer similar rates of response, but there are some differences in the ability of different agents to promote a full remission. The greatest chance of achieving full remission occurs early in the course of treatment; thus, initial antidepressant strategies should be those that have the greatest therapeutic potential. Other strategies that may help improve the chances of achieving full remission include optimizing drug dosages and using combination and augmentation strategies. Failure to achieve full remission and early discontinuation of antidepressant therapy have been associated with a greater incidence of relapse and recurrence. Continued antidepressant therapy has clearly been shown to effectively reduce the probability of relapse and recurrence by about half compared with placebo. Therefore, once a patient achieves remission, it is important to continue the same antidepressant therapy for at least 6-12 months and, for many patients, considerably longer. Medication should continue at the dose that was initially effective because using low-dose maintenance therapy appears to decrease the protective benefits.