Clinical issues in long-term treatment with antidepressants.
Historically, the emphasis in treating depression has been focused on the acute phase of treatment, with few published data on the continuation and maintenance phases of treatment. Yet the risk of depression increases with each episode, with a 50% to 90% chance of developing another episode after 1 or 2 prior episodes of depression. Moreover, subsequent episodes of depression are often of longer duration, more severe, and less responsive to treatment. Most patients with major depression require some form of long-term antidepressant treatment, and many need lifelong treatment. Optimizing efficacy and minimizing side effects are essential during both the acute and long-term phases of antidepressant treatment. Antidepressant side effects, including insomnia or somnolence, weight gain, asthenia, and sexual dysfunction, can significantly decrease patient compliance with long-term treatment for depression. Identification and management of side effects, combined with early and ongoing educational messages to the patient about treatment issues and the importance of sustaining illness remission, help improve compliance and reduce the potential for premature discontinuation of an otherwise optimal antidepressant.
Zajecka
J M
JM
Woman's Board Depression Treatment Research Center, Rush Presbyterian St. Luke's Medical Center, Chicago, Ill 60612, USA. jzajecka@rush.edu
D000928:Antidepressive Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D001247:Asthenia / Q000139:chemically induced / Q000628:therapy; D001294:Attitude to Health; D003866:Depressive Disorder / Q000188:drug therapy* / Q000517:prevention & control; D004334:Drug Administration Schedule; D001068:Feeding and Eating Disorders / Q000139:chemically induced / Q000628:therapy; D006801:Humans; D010349:Patient Compliance; D010353:Patient Education as Topic; D012008:Recurrence; D012720:Severity of Illness Index; D007319:Sleep Initiation and Maintenance Disorders / Q000139:chemically induced / Q000523:psychology / Q000628:therapy; D015430:Weight Gain
D000928:Antidepressive Agents