Maintenance therapy for chronic depression. A controlled clinical trial of desipramine.
BACKGROUND
Previous studies have shown the efficacy of antidepressants in the treatment of chronic depression. We report the results of a long-term study comparing desipramine hydrochloride and placebo for maintenance therapy of remitted patients with chronic depression.


METHODS
Outpatients who met DSM-III-R diagnostic criteria for "pure" dysthymia (n = 51), dysthymia with current major depression ("double depression") (n = 64), or chronic major depression (n = 14) were treated on an open basis with desipramine. Full and partial remitters after 10 weeks entered a continuation phase of open treatment with desipramine for 16 weeks. Remitted patients then were randomized to continue desipramine treatment or tapered to placebo treatment for a maintenance phase of up to 2 years. Relapse rates and time to relapse during maintenance therapy were compared between the two treatment groups.


RESULTS
Acute-phase treatment results did not differ significantly according to chronic depression subtype. Remission persisted with a high degree of stability during the continuation phase. Relapse rates during the maintenance phase were 52% for the placebo group and 11% for the active desipramine group (chi 2 = 8.1, P = .004). Most placebo relapses occurred during the first 6 months of maintenance therapy. Active medication was significantly more effective than placebo in that subgroup entering the maintenance phase in full remission and in those patients who fulfilled criteria for a diagnosis of pure dysthymia or double depression on entry to the study.


CONCLUSIONS
Long-term maintenance treatment with desipramine appeared to be effective in the prevention or postponement of relapse of depression in patients who responded to desipramine during the acute and continuation phases.
Kocsis
J H
JH
Department of Psychiatry, New York Hospital-Cornell Medical Center, New York, USA.
Friedman
R A
RA
Markowitz
J C
JC
Leon
A C
AC
Miller
N L
NL
Gniwesch
L
L
Parides
M
M
D000328:Adult; D017668:Age of Onset; D002908:Chronic Disease; D003866:Depressive Disorder / Q000188:drug therapy / Q000517:prevention & control* / Q000523:psychology; D003891:Desipramine / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D010919:Placebos; D011569:Psychiatric Status Rating Scales; D012107:Research Design / Q000592:standards; D016896:Treatment Outcome
D010919:Placebos; D003891:Desipramine