Rationale and options for the long-term treatment of depression

Depression is a chronic and disabling illness that frequently requires long-term maintenance treatment. The probability of recurrence after recovery is extremely high, especially amongst patients who have experienced previous episodes of depression. Indeed, once a patient has suffered from three episodes of depression, the likelihood that they will have another episode within the next 2 years is more than 95%. Despite this, depression remains an under-recognized and under-treated disease. Mirtazapine has shown sustained efficacy in the long-term treatment of depression, being more effective than amitriptyline and at least as effective as the selective serotonin reuptake inhibitors paroxetine and citalopram. It is also well tolerated over prolonged periods. It should therefore prove suitable for use as maintenance treatment in depressed patients.