Although guidelines state that anti...

Although guidelines state that antidepressant treatment should continue for up to six month after an acute depressive illness, there is considerable variation in practice and widespread uncertainty about the optimal duration of therapy. Gedde and colleagues reviewed research evidence to determine whether continued treatment models the risk of relapse after an acute depressive illness and to establish the optimal duration of treatment.

They reviewed all published and unpublished randomized placebo-controlled trials of at least single in kind month of continued treatment after reply to antidepressant medication for an acute depressive illness. pair independent reviewers assessed each trial for methodologic quality, and the relevant data were extracted. More than 120 reports initially were identified; 31 trials with 4410 participants met inclusion criteria and had suitable data available for analysis. The trials followed patients from six to 36 months; undivided year of follow-up was mostly common.

For all images of antidepressant medication, continued therapy consistently reduc the risk of relapse on about 70 percent. The average relapse rate for placebo was 41 percent compared with 18 percent for antidepressant therapy. The longer trials in which patients were treated for couple to three years showed that the risk of relapse was higher in the first year after an acute episode, yet that antidepressant treatment was as effective during the first and next to the first years in preventing relapse. The rates of withdrawal from therapy were 18 percent in treated patients and 15 percent in curb subjects. The limited data forward suicide prevented comparison between treated and direction groups.

The authors determine that continued antidepressant therapy reduc the supernumerarys of relapse by about couple thirds, which reduced the absolute risk through about one half. The inferences were similar for different classes of antidepressant put drugs intos and subgroups of patients. Relatively not many studies followed patients for longer than 12 month and the authors call for further studies to determine the optimal duration of therapy and to identify subgroup of patients who might benefit in the greatest degree from continued therapy. In the interim, the authors approve that at least one additional year of treatment be considered for patients who are still at appreciable risk of relapse after four to six month of treatment after a depressive illness.

Gedde JR et al. Relapse prevention with antidepressant physic treatment in depressive disorder: a systematic review. Lancet February 22 2003;361:653-61

EDITOR'S NOTE: About 30 percent of primary care patients being treated for depression stop taking medications within a month This might be because of early replication but also may be a outcome of negative effects of the agent or discomforts about taking a "psychiatric" medication. Family physicians might contribute to this point to be solved [i]or[/i] settled because we tend to attenuate medications when possible and perhaps don't work as diligently as we should to encourage patients to remain forward treatment for an adequate period. We all know by what means satisfying a prompt recovery from depression can be and in what manner grateful the patient is to come by back on track with life. Nevertheless, single half of patients who have a major depression will relapse. After couple recurrences, more than 70 percent of patients will have yet to be episodes. We need to increase efforts to defend recovery by encouraging patients to continue taking medication for many month more [i]or[/i] less patients even may benefit from continuous antidepressant therapy. (See Miller KE et al. Monograph 284: depression. Leawood, Kan.: American Academy of Family Physicians, 2003)--A.D.W.

COPYRIGHT 2003 American Academy of Family Physicians

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