[Consolidation treatment. The status in dysthymia]

It is now recognised that the treatment of depressive episodes comprises three distinct phases: the phase of acute treatment, which should lead to symptomatic remission; the phase of continuation, which aims to obtain cure by preventing relapses; and the phase of maintenance or prophylactic treatment, the object of which is to prevent recurrence, that is to say the occurrence of a new depressive episode independent of the earlier one. The application of such a therapeutic protocol to mood alterations raises a number of questions. In the first place, it should be emphasised that the fluctuating character and low intensity of the mood-changing symptoms, as well as the normally progressive action of antidepressants over time may make it very difficult to date the onset of remission. For this reason, the phases of acute treatment and of consolidation may not be discernible for a certain period of time. Furthermore, the chronicity of time-course being one of the principal characteristics of dysthymias, the only effective long-term therapeutic strategy may be to pursue continuation treatment instead of maintenance treatment, on the grounds that every new symptomatic manifestation should be regarded as a relapse rather than a recurrence. The duration of continuation treatment is poorly defined. If credence is lent to the rule which states that a depressive state should be treated for as long as the prior history has lasted, consolidation treatment of dysthymias should be continued for several years--two at least, more frequently more, and sometimes indefinitely.(ABSTRACT TRUNCATED AT 250 WORDS)