Long-term clinical management of depressive disorders

The author provides evidence that depression is an often chronic and recurrent illness. He then provides World Health Organization (WHO) and other well-established recommendations for acute treatment of depression and describes maintenance treatment, which usually lasts 3 to 6 months. He lists WHO recommendations for prophylaxis, which should probably be continued for 2 or more years in patients with chronic depression, and reviews the following problems commonly associated with continued antidepressant treatment: cardiac toxicity, drug overdose, suicide/parasuicide, drug toxicity, drug interactions, and noncompliance. Finally, the author discusses discontinuation, which should always be accomplished according to a tapered, individualized schedule with the patient as an active partner in the process. Despite this knowledge, researchers must look for additional therapies for the one third of depressed patients who are not helped by currently available measures.