Initial effectiveness, partial remission, and full remission in depression: focus on long-term treatment with SNRIs.
Full remission, defined as the absence of all significant symptoms of depression over at least 6 months, is the ultimate goal of antidepressant therapy. Remission takes time and studies have shown that remission rates continue to rise for at least 3 months after initial improvement. Depression is a recurrent condition with a cumulative probability of recurrence of 40% over 2 years and 70% over 5 years after the first depressive episode. In addition the risk of recurrence increases with each new depressive episode. Continuing antidepressant treatment beyond the acute response significantly decreases the risk of recurrence. A double-blind study with the serotonin norepinephrine reuptake inhibitor milnacipran, for example, has shown that patients in remission following treatment with milnacipran who continued the active treatment for a further 12 months had significantly less relapse (P<.05) than those switched to placebo. In spite of the importance of maintaining antidepressant therapy, many patients do not continue treatment. Among the principal reasons for this are side effects and worries of psychological or physical dependence. To reduce the risk of relapse, treatment with effective, well-tolerated antidepressants with few withdrawal effects should be pursued for at least 6 months and possibly longer in patients already experiencing relapse.
Dursun
Serdar
S
Department of Psychiatry, University of Alberta, Edmonton, Canada. dursun@ualberta.ca
D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003863:Depression / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D008137:Longitudinal Studies; D055502:Secondary Prevention; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D013997:Time Factors
D000928:Antidepressive Agents; D017367:Selective Serotonin Reuptake Inhibitors