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Five-year outcome for maintenance therapies in recurrent depression
D J Kupfer1, E Frank, J M Perel
1Department of Psychiatry, University of Pittsburgh School of Medicine, PA 15213.
Archives of General Psychiatry
|October 1, 1992
Summary
Maintaining imipramine hydrochloride medication for recurrent depression beyond three years significantly prevents relapse. Patients with shorter intervals between episodes benefit from at least five years of continuous prophylactic treatment.
Area of Science:
- Psychiatry
- Clinical Psychology
- Pharmacology
Background:
- Recurrent depression poses a significant challenge requiring long-term management strategies.
- Previous research established the efficacy of imipramine hydrochloride and interpersonal psychotherapy for acute and continuation treatment.
Purpose of the Study:
- To evaluate the long-term prophylactic effect of maintaining imipramine hydrochloride treatment beyond three years in patients with recurrent depression.
- To compare the efficacy of continued active medication versus placebo in preventing depressive relapse.
Main Methods:
- A 5-year randomized trial involving 128 patients with recurrent depression who initially responded to imipramine hydrochloride and interpersonal psychotherapy.
- Patients completing 3 years of maintenance treatment were randomized to either continued active imipramine hydrochloride or placebo for an additional 2 years.
Main Results:
- Survival analysis revealed a statistically significant continued prophylactic effect of imipramine hydrochloride at an average dose of 200 mg.
- Discontinuation of imipramine hydrochloride led to a higher rate of depressive recurrence compared to continued treatment.
Conclusions:
- Sustained imipramine hydrochloride treatment is effective in preventing recurrent depression beyond three years.
- Patients with recurrent depression and episode intervals under 2.5 years warrant at least five years of prophylactic treatment.