Relapse and recurrence in unipolar major depression: short-term and long-term approaches

Relapse and recurrence following successful short-term treatment of major depression are common and vexing clinical problems. The risk of relapse and recurrence is reviewed, as is evidence pertaining to pharmacologic and psychosocial strategies for continuation and maintenance therapy. Up to 6 months' continuation treatment following short-term treatment response is recommended routinely for virtually all patients. Based on available evidence, a more prolonged course of maintenance pharmacotherapy is strongly recommended for patients with residual symptomatology and/or a past history of chronicity or multiple depressive episodes. Further research is necessary to identify the specific indications for combining psychotherapy and pharmacotherapy.