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Relapse and Recurrence of Depression

A Practical Approach for Prevention

  • Practical Therapeutics
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Summary

Most major affective disorders are, from a longitudinal perspective, recurrent conditions. This article reviews the rationale for longer term models of antidepressant treatment, including strategies for the prevention of relapse (defined as an increase of symptoms back to a syndromallevel after an initial treatment response) and recurrence (defined as the onset of a distinctly new episode of affective illness).

To prevent relapse, it is recommended that all patients whose symptoms remit during pharmacotherapy receive 4 to 6 months of continuation therapy. Those patients at increased risk for subsequent recurrent depressive episodes should be considered for an extended course of maintenance pharmacotherapy. The efficacy of tricyclic antidepressants, lithium and the selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors for the prevention of recurrent depression has been established, with the latter class having a clinical advantage in terms of common adverse effects and safety in overdose.

With each new episode of depressive illness, the risk of illness becoming more autonomous, severe and potentially refractory may increase. Thus, prophylactic treatment of patients at risk of recurrent depression remains the best way to optimise their long term outcome.

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  1. Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O’Hara Street, Pittsburgh, Pennsylvania, 15213, USA

    Michael E. Thase & Lawrence R. Sullivan

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Thase, M.E., Sullivan, L.R. Relapse and Recurrence of Depression. CNS Drugs 4, 261–277 (1995). https://doi.org/10.2165/00023210-199504040-00004

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