Few studies have compared the available antidepressants in terms of effectiveness in long-term treatment of Major Depressive Disorder (MDD) (Furukawa et al., 2007; Hansen et al., 2008).

Long-term prevention of relapses/recurrence should be the main goal of maintenance MDD treatment.

Purpose of the present study was to compare the different antidepressants in terms of retention in treatment (no discontinuation for relapses, hospitalizations or side effects).

150 outpatients with a MDD diagnosis and treated with antidepressants in mono-therapy have been included. Follow-up period was defined in 24 months and information have been obtained from charts, interviews with patients and their relatives and from the Lombardy regional database. A survival analysis (Kaplan-Meier) was performed, considering recurrences, hospitalizations or discontinuation due to side effects as ’death’ events.

48.7% out of patients presented a recurrence within the first two years after the beginning of antidepressant treatment. With the exception of Fluoxetine (p=0.09), Amitriptiline (p=0.13), Fluvoxamine (p=0.83), Venlafaxine (p=0.5) and Trazodone (p=0.58), Bupropione appears to be less effective in long-term treatment of MDD compared to other antidepressants. Fluvoxamine appears to be less effective compared to Citalopram (p=0.036), Paroxetine (p=0.037), Clomipramine (p=0.05), Sertraline (p=0.011) and Duloxetine (p=0.024).

Bupropione and Fluvoxamine would be less effective in long-term treatment of depression. These data should be confirmed by prospective studies with large samples.