Five to fifteen years' maintenance doxepin therapy

The subject of this presentation is depression in patients with concomitant chronic disease. With this focus, it is perhaps easy to overlook the fact that, for many patients, depression is, in itself, a chronic condition requiring a long-term management strategy. The most familiar model of depression is that of an illness which, though it may have been present for a long period, is usually curable with an 8 to 12 month course of medication. An unknown number of depressed patients, however, may require long-term or maintenance antidepressant drug therapy. The definition, recognition, and management of chronic depression are briefly reviewed. An ongoing prospective study of the long term (5-15 years) use of doxepin indicates that this tricyclic antidepressant is feasible, efficacious, and safe in the treatment of judiciously selected and carefully monitored patients. Advantages of doxepin therapy include its lack of adverse interactions with prescription and non-prescription drugs taken by these patients and the high degree of safety seen in patients with concomitant cardiovascular and other physical disorders. Thus, doxepin appears to be a suitable drug for the long-term maintenance outpatient treatment of chronic depression.