Long-term treatment of depression with antidepressants: a systematic narrative review

To examine the available scientific evidence for answers to clinically relevant questions on the effectiveness and tolerability of antidepressant drugs (ADs) for the long-term treatment of depression.

The Cochrane Library was searched up to July 2006. When no complete Cochrane review was available, we looked in PubMed for relevant systematic reviews or individual randomized controlled trials.

There was no good evidence that increasing the dosage of the initial AD is an effective strategy for patients with no, or partial, response to acute-phase treatment. There was no good evidence that switching between chemical classes of antidepressant was more effective than switching within a class. There was limited support from randomized trials for several augmentation strategies. There was good evidence for the effectiveness of long-term therapy to prevent relapse in patients who remitted after acute-phase treatment. The application of principles of evidence-based medicine suggested that thoughtful, individualized application of evidence is more appropriate than general statements.

Available evidence provides some support for the effectiveness of several augmentation strategies in the management of patients with no, or partial, response to acute-phase treatment and for the individualized application of groupwise robust evidence for maintenance treatment with ADs to prevent relapses. However, side effects of these long-term treatments with ADs are poorly studied and reported.