[Relapse in depressive disorders--is there a need for maintenance psychotherapy? ]

Patients with depressive disorders who enroll in typical short-term clinical studies have a high risk of early relapse (30-70 %) and chronicity (ca. 20 %). Factors which contribute to this risk are residual symptoms at termination, previous recurrent episodes, chronic stress, etc. Pharmacological strategies offer a multitude of means of relapse prevention, while in psychotherapeutic interventions there is a dearth of such recommendations. Studies on relapse-preventing continuous contacts (maintenance therapy), for example, are very rare.

We present empirical data on risk factors for early relapse and chronic course in depressive disorders together with general strategies for relapse prevention. Results of controlled studies with maintenance psychotherapy will then be reported.

Psychotherapeutic maintenance strategies have been shown to be successful in several controlled studies. Furthermore, recent studies show typical moderating mechanisms for better resilience against stressors in formerly depressed patients. The typical setting under study was monthly sessions over a period of at least 8 months and up to three years. In case of severe risk factors continuous pharmacotherapy also has to be taken into consideration.

The issue is discussed in respect to differential indication (primarily long-term therapy vs. a rather quick change to maintenance contacts of low frequency). Moreover, the ethical questions of inadequate dependency as well as the clinical aspects of transference-countertransference dynamics are viewed.