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Long-Term Treatment of Patients with Recurrent Unipolar Major Depression: Evidence to Clinical Practice

Published online by Cambridge University Press:  07 November 2014

Extract

Major depressive disorder (MDD) is almost exclusively recurrent. The vast majority of patients who experience one episode of MDD will eventually experience at least one more episode during their lifetime. The recurrent nature of MDD increases the burden to both the individual and society. Hence, it is imperative that treatment strategies focus on achieving remission acutely, as well as maintaining of remission and preventing recurrence. The articles in this supplement are based on presentations and a dialogue among a group of experts who convened for a roundtable discussion on improving long-term outcomes with antidepressant therapy.

Improving long-term treatment of MDD begins with understanding the clinical course of recurrent depression and the ability to recognize those patients who are at greatest risk for recurrence. James H. Kocsis, MD, reviews the course of recurrent depression, emphasizing the tendency for it to progressively worsen. He also discusses patient characteristics and other risk factors for recurrence as well as current recommendations for long-term management of recurrent depression.

Although long-term antidepressant maintenance treatment studies are somewhat limited in number, they provide the evidence base that shapes existing guidelines for long-term management of recurrent depression. Michael E. Thase, MD, examines this evidence for the different classes of antidepressants. In addition, Thase reviews evidence for the efficacy of psychotherapy and discusses its potentially important role in long-term depression management.

Type
Supplement
Copyright
Copyright © Cambridge University Press 2006

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References

REFERENCES

1.Keller, MB, Shapiro, RW. Major depressive disorder. Initial results from a one-year prospective naturalistic follow-up study. J Nerv Ment Dis. 1981;169:761768.CrossRefGoogle ScholarPubMed
2.Keller, MB, Boland, RJ. Implications of failing to achieve successful long-term maintenance treatment of recurrent unipolar major depression. Biol Psychiatry. 1998;44:348360.CrossRefGoogle ScholarPubMed
Keller, MB. Depression: a long-term illness. Br J Psychiatry Suppl. 1994:915.Google Scholar
4.Lavori, PW, Keller, MB, Mueller, TI, Scheftner, W, Fawcett, J, Coryell, W. Recurrence after recovery in unipolar MDD: an observational follow-up study of clinical predictors and somatic treatment as a mediating factor. Int J Methods Psychiatr Res. 1994;4:211229.Google Scholar
Mueller, TI, Leon, AC, Keller, MB, et al.Recurrence after recovery from major depressive disorder during 15 years of observational follow-up. Am J Psychiatry. 1999;156:10001006.CrossRefGoogle ScholarPubMed
Solomon, DA, Keller, MB, Leon, AC, et al.Recovery from major depression. A 10-year prospective follow-up across multiple episodes. Arch Gen Psychiatry. 1997;54:10011006.CrossRefGoogle ScholarPubMed
7.Solomon, DA, Keller, MB, Leon, AC, et al.Multiple recurrences of major depressive disorder. Am J Psychiatry. 2000;157:229233.CrossRefGoogle ScholarPubMed
Greenberg, PE, Kessler, RC, Birnbaum, HG, et al.The economic burden of depression in the United States: how did it change between 1990 and 2000? J Clin Psychiatry. 2003;64:14651475.CrossRefGoogle ScholarPubMed
9.Kessler, RC, Berglund, P, Demler, Oet al.The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA. 2003;289:30953105.CrossRefGoogle ScholarPubMed
10. Keller, M, Yan, B, Dunner, D. Recurrence prevention: Efficacy of two years of maintenance treatment with venlafaxine XR in patients with recurrent unipolar depression. Poster presented at: the Annual Meeting of the American Psychiatric Association Annual Meeting: May 20-25, 2006: Toronto, Canada.Google Scholar
11.Ninan, PT, Kornstein, SG, Kocsis, JH, et al.Efficacy of two years of maintenance treatment with venlafaxine extended release 75-225 mg/d in patients with recurrent unipolar major depression. Poster presented at: the 6th International Forum on Mood and Anxiety Disorders; November 29 to December 1, 2006: Vienna, Austria.Google Scholar