Maintenance phase efficacy of sertraline for chronic depression: a randomized controlled trial.
BACKGROUND
The chronic form of major depression is associated with a high rate of prevalence and disability, but no controlled research has examined the impact of long-term treatment on the course and burden of illness.


OBJECTIVE
To determine if maintenance therapy with sertraline hydrochloride can effectively prevent recurrence of depression in the high-risk group of patients experiencing chronic major depression or major depression with antecedent dysthymic disorder ("double depression").


METHODS
A 76-week randomized, double-blind, parallel-group study, conducted from September 1993 to November 1996.


METHODS
Outpatient psychiatric clinics at 10 academic medical centers and 2 clinical research centers.


METHODS
Maintenance treatment with either sertraline hydrochloride (n = 77) in flexible doses up to 200 mg or placebo (n = 84).


METHODS
A total of 161 outpatients with chronic major or double depression who responded to sertraline in a 12-week, double-blind, acute-phase treatment trial and continued to have a satisfactory therapeutic response during a subsequent 4-month continuation phase.


METHODS
Time to recurrence of major depression.


RESULTS
Sertraline afforded significantly greater prophylaxis against recurrence than did placebo (5 [6%] of 77 in the sertraline group vs 19 [23%] of 84 in the placebo group; P = .002 for the log-rank test of time-to-recurrence distributions). Clinically significant depressive symptoms reemerged in 20 (26%) of 77 patients treated with sertraline vs 42 (50%) of 84 patients who received placebo (P = .001). With use of a Cox proportional hazards model, patients receiving placebo were 4.07 times more likely (95% CI, 1.51-10.95; P = .005) to experience a depression recurrence, after adjustment for study site, type of depression, and randomization strata.


CONCLUSIONS
Maintenance therapy with sertraline is well tolerated and has significant efficacy in preventing recurrence or reemergence of depression in chronically depressed patients.
Keller
M B
MB
Department of Psychiatry, Butler Hospital, Brown University, Providence, RI 02906, USA.
Kocsis
J H
JH
Thase
M E
ME
Gelenberg
A J
AJ
Rush
A J
AJ
Koran
L
L
Schatzberg
A
A
Russell
J
J
Hirschfeld
R
R
Klein
D
D
McCullough
J P
JP
Fawcett
J A
JA
Kornstein
S
S
LaVange
L
L
Harrison
W
W
D000328:Adult; D000928:Antidepressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002908:Chronic Disease; D017281:Cost of Illness; D003866:Depressive Disorder / Q000188:drug therapy*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D020280:Sertraline / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome
D000928:Antidepressive Agents; D017367:Selective Serotonin Reuptake Inhibitors; D020280:Sertraline