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The Prophylactic Efficacy of Fluoxetine in Unipolar Depression

Published online by Cambridge University Press:  06 August 2018

S. A. Montgomery*
Department of Psychiatry, St Mary's Hospital Medical School, London
H. Dufour
Department of Psychiatry, CHU Timone, Marseille
S. Brion
Department of Psychiatry, Hopital Richaud, Versailles
J. Gailledreau
Department of Psychiatry, Hopital Richaud, Versailles
X. Laqueille
Department of Psychiatry, Hopital Richaud, Versailles
G. Ferrey
Department of Psychiatry, CHS, Eaubonne
P. Moron
Department of Psychiatry, Hopital de la Grave, Toulouse
N. Parant-Lucena
Department of Psychiatry, Hopital de la Grave, Toulouse
L. Singer
Department of Psychiatry, Hospices Civils, Strasbourg
J. M. Danion
Department of Psychiatry, Hospices Civils, Strasbourg
J. N. Beuzen
Lilly France, Saint-Cloud
M. A. Pierredon
Lilly France, Saint-Cloud


The efficacy of antidepressants is measured primarily by their ability to treat the acute symptoms of depression yet the underlying process may take longer to resolve. A period of emotional frailty follows resolution of the acute stage, during which the patient, although apparently symptom-free, is prone to suffer relapse of the original symptoms. Antidepressants should not be stopped immediately a response is observed, but should be given for a longer period to prevent early relapse. In those suffering from recurrent depression, long-term treatment may prevent later recurrences of new episodes of depression.

The distinction between relapse of old symptoms and recurrence of new episodes is of particular importance, both in assessing efficacy of antidepressants during the continuation phase of acute treatment and in the separate assessment of their prophylactic efficacy. Unfortunately, though, many investigations have failed to distinguish between these two distinct phenomena. Klerman & Paykel (1970) emphasised the need to distinguish between early return of depressive symptoms, which they label ‘relapses’, from the later new episodes which they term ‘recurrence’. However, there has been a general lack of systematic investigation of this question, as well as a failure to use sufficiently precise methodology to distinguish between relapse and recurrence. Some studies which purported to be of prophylaxis were in effect only examining the continuation phase of acute treatment.

Research Article
Copyright © 1988 The Royal College of Psychiatrists 

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Bjork, K. (1983) The efficacy of zimeldine in preventing depressive episodes in recurrent major depressive disorders - a double blind placebo-controlled study. Acta Psychiatrica Scandinavica, 68, 182189.CrossRefGoogle Scholar
Coppen, A., Montgomery, S. A., Gupta, R. K. & Bailey, J. E. (1976) A double-blind comparison of lithium carbonate and maprotiline in the prophylaxis of the affective disorders. British Journal of Psychiatry, 128, 479485.CrossRefGoogle ScholarPubMed
Coppen, A., Ghose, K., Montgomery, S., Rama Rao, V. A., Bailey, J. & Jorgensen, A. (1978a) Continuation therapy with amitriptyline in depression. British Journal of Psychiatry, 133, 2833.CrossRefGoogle Scholar
Coppen, A., Ghose, K. & Rao, R., Bailey, J. & Peet, M. (1978b) Mianserin and lithium in the prophylaxis of depression. British Journal of Psychiatry, 133, 206210.CrossRefGoogle Scholar
Fabre, L. F. & Feighner, J. P. (1983) Long-term therapy for depression with trazodone. Journal of Clinical Psychiatry, 44, 1721.Google ScholarPubMed
Glen, A. I. M., Johnson, A. L. & Shepherd, M. (1984) Continuation therapy with lithium and amitriptyline in unipolar depressive illness: a randomized, double-blind, controlled trial. Psychological Medicine, 14, 3750.CrossRefGoogle ScholarPubMed
Kane, J. M., Quitkin, F. M., Rifkin, A., Ramos-Lorenzi, J. R., Nayak, D. D. & Howard, A. (1982) Lithium carbonate and imipramine in the prophylaxis of unipolar and bipolar II illness. Archives of General Psychiatry, 39, 10651069.CrossRefGoogle ScholarPubMed
Kay, D. W. K., Fahy, T. & Garside, R. F. (1970) A seven-month double-blind trial of amitriptyline and diazepam in ECT-treated depressed patients. British Journal of Psychiatry, 117, 667671.CrossRefGoogle ScholarPubMed
Klerman, G. L. & Paykel, E. S. (1970) Long-term drug therapy in affective disorders. International Pharmacopsychiatry, 5, 8099.CrossRefGoogle Scholar
Klerman, G. L., Dimascio, A., Weissman, M., Prusoff, B. & Paykel, E. (1974) Treatment of depression by drugs and psychotherapy. American Journal of Psychiatry, 131, 186191.CrossRefGoogle Scholar
Mindham, R. H. S., Howland, C. & Shepherd, M. (1973) An evaluation of continuation therapy with tricyclic antidepressants in depressive illness. Psychological Medicine, 3, 517.CrossRefGoogle ScholarPubMed
MRC Drug Trials Subcommittee (1981) Continuation therapy with lithium and amitriptyline in unipolar depressive illness: a controlled clinical trial. Psychological Medicine, 11, 409416.CrossRefGoogle Scholar
Prien, R. & Kupfer, D. J. (1986) Continuation drug therapy for major depressive episodes: how long should it be maintained? American Journal of Psychiatry, 143, 1823.Google ScholarPubMed
Prien, R., Klett, C. J. & Caffey, E. M. (1973) Lithium carbonate and imipramine in the prevention of affective episodes. Archives of General Psychiatry, 29, 420425.CrossRefGoogle ScholarPubMed
Prien, R., Kupfer, D. J., Mansky, P. A., Small, J. G., Tuason, V. B., Voss, C. B. & Johnson, W. E. (1984) Drug therapy in the prevention of recurrences in unipolar and bipolar affective disorders. Archives of General Psychiatry, 41, 10961104.CrossRefGoogle ScholarPubMed
Schou, M. (1979) Lithium as a prophylactic agent in unipolar affective illness. Archives of General Psychiatry, 36, 849851.CrossRefGoogle ScholarPubMed
Seager, C. P. & Bird, R. L. (1962) Imipramine with electrical treatment in depression - a controlled trial. Journal of Mental Science, 108, 704, 707.CrossRefGoogle ScholarPubMed
Stark, P. & Hardison, C. D. (1985) A review of multicentre controlled studies of fluoxetine vs imipramine and placebo in outpatients with major depressive disorder. Journal of Clinical Psychiatry, 46, 5358.Google Scholar
Stein, M., Rickels, K. & Weise, C. C (1980) Maintenance therapy with amitriptyline: a controlled trial. American Journal of Psychiatry, 137, 370371.Google ScholarPubMed
Storer, D., Eastwood, P. & Bailey, E. (1980) Long-term comparison of nomifensine and imipramine in the treatment of depression. In Nomifensine, Royal Society of Medicine International Congress and Symposium Series No. 25 (eds P. D. Stonier & F. A. Jenner) pp. 109-115. London: Academic Press.Google Scholar
Wernicke, J. F., Dunlop, S. R., Dornseif, B. E. & Zerbe, R. L. (1987) Fixed-dose fluoxetine therapy for depression. Psychopharmacology Bulletin, 23, 164168.Google Scholar
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