[Long-term clinical effects of antidepressive agents]

According to long term studies with antidepressants versus placebo, the therapeutic efficacy is prolonged: a long term treatment in full dosage seems to reduce from almost half the risk of relapse and recurrence till five years, during recurrent major affective disorders. We should therefore be cautious and we should not have a systematic prescription for all types of depressions; antidepressants are efficacious but have side effects and we do not know well their abilities in long term use. During bipolar disorders the prescription of long term antidepressants, even in association with normothymics, does not give benefits and can induce rapid cycles. In dysthymias and depressions with personality disorders, a psychotherapy is indicated, and it is difficult to evaluate the efficacy of a long term antidepressant treatment. Tricyclics antidepressants, MAOI's and SSRI's have classical side effects, and they can also induce: modifications of the symptomatology, of cognitive functions, of sleep, eating and sexual behaviours; modifications of the course of depressive illness, induction of manic switches, and may be sometimes an exacerbation of suicidal ideation ... pharmacogenetic modifications with their action on hepatic metabolism, neuroendocrine alterations and long term effects on monoamines. We have also to take into account the long term treatment consequences on quality of life, on self esteem with the importance of psychodynamic and relationships modifications. The use of a long term antidepressant treatment should be adapted to each individual, being cautious of its potential benefits and risks.