S23. Long-term management of depressive disorders (supported by an educational grant from Lundbeck DK)

1994 European psychiatry  
Clinicians mostly agree about the need to continue antidepressant medication until a current episode has resolved (continuation therapy). However, whether patients who have fully recovered should continue to receive medication in an attempt to prevent a future episode from taking place (maintenance therapy) is a more controversial one. The data of recent longitudional studies indicate that mood disorders tend to be recurrent and lifetime in nature and that multiple episodes are the norm and not
more » ... re the norm and not the exception. Furthermore, it has been found that the cycle length has a tendency to shorten with each new episode, and that the interval of being well between the first and second episodes was longer than the one between each subsequent set of episodes. Additionally, there is convincing evidence that increasing episodes excert an increasing risk factor for the occurance of another episode. A further important point, derived from epidemiological data is the finding that the older the patients are at the onset of the index episode, the more likely are early relapses if they remain untreated. Based on these findings it seems therefore that age of onset of first episode and number of prior episodes are prominent predictors for future episodes. Although there is a lack of systematic studies to answer the question of when to begin maintenance therapy, there is clinical evidence that patients with more than three depressive episodes and those who are older than 50 years at first onset are at high risk of repeated depressive episodes. The number of phases and age of onset appear to be interactive, and it is probable that patients with more than three episodes (regardless of their age), and those who are aged over 50 years at the time of first onset are likely to benefit from maintenance treatment. Further variables (besides polarity, number of previous episodes, age of onset of first and index episode) which have been discussed to be predictive for a relapse in depression are: severity of index episode, work adjustment, social and leisure activity, gender, family history of depression and presence of other psychiatric or physical disorders (co-morbidity), like double depression (major depression + dysthymia), combined depression (major depression + recurrent brief depression). MANAGEMENT OF CHRONIC, RECURRENT DEPRESSION
doi:10.1017/s0924933800004612 fatcat:tbxriyeherdmncddacnbn7ge3e