Studies of Long-Term Use of Antidepressants
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Depression is a recurrent illness in which afflicted individuals have an increased risk for recurrence as a function of a greater number of previous episodes. Consequently, prevention of future episodes is central to improving the prognosis. The current recommendation is to use antidepressants over prolonged periods of time to prevent further episodes of depression. However, the database for this practice is limited and can be interpreted in multiple ways. Review of the relevant literature was performed. MEDLINE and PubMed databases were searched from inception to 5 September 2011 for randomized, placebo-controlled trials of at least 18 months duration. After treatment of an acute depressive episode, antidepressants clearly prevent relapse back into the same depressive episode. This is demonstrated by an adequate number of randomized, blinded, placebo-controlled, 1-year continuation trials. The ability of antidepressants to prevent recurrence of future episodes is less clear. Randomized, blinded, placebo-controlled trials of 18 months or longer are infrequent-18 studies were identified. While nearly all show that antidepressant continuation is superior to placebo in preventing resurgence of depressive symptoms, nearly all of the difference occurs in the first 6 months after randomization. This pattern strongly suggests that the apparent superiority of antidepressants may be due to (i) their ability to prevent recurrence, (ii) antidepressant withdrawal (characterized by depressive symptoms) in patients switched to placebo or (iii) a combination of these phenomena.
KeywordsImipramine Sertraline Venlafaxine Depressive Episode Nortriptyline
Dr Briscoe does not have any conflicts of interest to report. Over the last 5 years, Dr El-Mallakh has received honoraria for being on the speakers’ bureau of the following pharmaceutical companies: Angelini Labopharm, AstraZeneca, Bristol Myers Squibb, Lilly, Merck, Novartis and Pfizer. There are no other conflict of interests to report. This preparation of this review was not supported by any extramural funds.
- 11.American Psychiatric Association. Practice guideline for the treatment of patients with major depressive disorder (revision): American Psychiatric Association. Am J Psychiatry 2000; 157(4 Suppl.): 1–45Google Scholar
- 16.Papakostas GA, Charles D, Fava M. Are typical starting doses of the selective serotonin reuptake inhibitors suboptimal? A meta-analysis of randomized, double-blind, placebo-controlled, dose-finding studies in major depressive disorder. World J Biol Psychiatry 2010; 11 (2 Pt 2): 300–7PubMedCrossRefGoogle Scholar
- 26.Prien RF, Kupfer DJ, Mansky PA, et al. Drug therapy in the prevention of recurrences in unipolar and bipolar affective disorders: report of the NIMH Collaborative Study Group comparing lithium carbonate, imipramine, and a lithium carbonate-imipramine combination. Arch Gen Psychiatry 1984; 41: 1096–104PubMedCrossRefGoogle Scholar
- 43.Briscoe B, El-Mallakh RS. The evidence base for the long-term use of antidepressants as prophylaxis against future depressive episodes. Presented at the Annual Meeting of the American Psychiatric Association; 2010 May 24–26; New Orleans, (LA)Google Scholar
- 56.El-Mallakh RS, Roberts RJ, Swann A, et al. Tardive dysphoria: antidepressant-induced chronic depression. Irish J Psychol Med. In pressGoogle Scholar