Long-term treatment strategies in affective disorders

Unipolar major depression is a disorder with a high incidence of relapse and recurrence. Some patients with major depression fail to recover from an episode and develop chronic depression. Both episodic and chronic depression are associated with considerable morbidity and mortality. An improved long-term outcome for patients may be achieved by the use of longer courses of treatment in the management of depression, which may ultimately enable recovery from depressive symptoms. The data reviewed in this article indicate that both selective serotonin reuptake inhibitors (SSRIs) and the serotonin and norepinephrine reuptake inhibitor (SNRI) venlafaxine are effective in reducing the incidence of relapse during 6 months of continuation therapy for major depression. In addition, longer-term treatment using imipramine or venlafaxine has shown maintenance therapy to be effective in reducing the risk of recurrence of major depression. Pharmacotherapy using sertraline or imipramine for extended periods of time has also been shown to be effective in attaining remission from, and preventing, recurrence of symptoms in patients with chronic depression. The data reviewed suggest that long-term therapy is beneficial in achieving a sustained return to complete functioning for patients with depression. The significantly higher remission rates attained with venlafaxine treatment as compared with some SSRIs warrant further studies of SNRIs for the long-term treatment of depression.