107 Even when a reversible underlying medical condition is contributing to depression, treatment of that condition alone is not always sufficient to resolve the depression. Furthermore, some of
the medications used to treat comorbid medical conditions may induce or worsen a depressive episode. Depression is a risk factor for mortality after acute Inhibitors,research,lifescience,medical myocardial infarction (MI) and a morbidity risk factor associated with slow recovery from an MI and poorer quality of life.108-111 Recent trials with SSRIs are pointing to these medications as safe and effective treatment for recurrent depression with recent MI or unstable angina, although a beneficial effect on the underlying cardiac disease has not been found consistently in studies to date.112,113 It is likely Inhibitors,research,lifescience,medical that similar findings will STAT inhibitor emerge from intervention studies in depression and other concurrent serious medical conditions. Continuation/maintenance treatment Clinical guidelines generally recommend that treatment should be continued for at least 6 months following remission of acute symptoms.114,115 However, because of the recurrent nature of depressive disorder, a question is how long patients at risk of recurrence
Inhibitors,research,lifescience,medical should remain on antidepressant medication. A recent review Inhibitors,research,lifescience,medical of data from longer-term studies116 pooling 31 randomized trials, demonstrated that continuing treatment reduced the odds of relapse by 70% (95% confidence interval [CI] 62% to 78%) compared to treatment discontinuation. The average rate of relapse or recurrence on placebo was 41% compared with 18% on active treatment. Most of the trials were of only 12 months5 duration. Thus, the evidence on longer-term treatment requires confirmation;
Inhibitors,research,lifescience,medical however, in the longer trials evaluated, the treatment effect appeared to persist for up to 36 months. This new analysis reinforces the available findings not from long-term maintenance trials conducted with TCA. The Prien et al21 and Frank et al22 maintenance studies with imipramine in mid-life adults, followed by the Reynolds et al23 study in late-life depression with nortriptyline, established the efficacy of long-term maintenance treatment with antidepressants, specifically in recurrent major depression. Subsequent studies with SSRIs have pointed to similar levels of efficacy with fluoxetine, sertraline, and citalopram in mid-life patients and with citalopram in late-life patients, most of whom had experienced at least one prior episode of depression.