Loss of Antidepressant Efficacy During Maintenance Therapy: Possible Mechanisms and Treatments
J Clin Psychiatry 1998;59(6):279-288
© Copyright 2015 Physicians Postgraduate Press, Inc.
Purchase This PDF for $40.00
If you are not a paid subscriber, you may purchase the PDF.
(You'll need the free Adobe Acrobat Reader.)
Receive immediate full-text access to JCP. You can subscribe to JCP online-only ($86) or print + online ($156 individual).
With your subscription, receive a free PDF collection of the NCDEU Festschrift articles. Hurry! This offer ends December 31, 2011.
If you are a paid subscriber to JCP and do not yet have a username and password, activate your subscription now.
As a paid subscriber who has activated your subscription, you have access to the HTML and PDF versions of this item.
Click here to login.
Did you forget your password?
Still can't log in? Contact the Circulation Department at 1-800-489-1001 x4 or send email
Background: Many patients with unipolar
depression experience a return of depressive symptoms while
taking a constant maintenance dose of an antidepressant.
Method: All cited studies were found using
computerized literature searches of the MEDLINE database since
Results: The return of depressive symptoms
during maintenance antidepressant treatment has occurred in 9% to
57% of patients in published trials. Possible explanations
include loss of placebo effect, pharmacologic tolerance, increase
in disease severity, change in disease pathogenesis, the
accumulation of a detrimental metabolite, unrecognized rapid
cycling, and prophylactic inefficacy.
Conclusion: Although several strategies have
been proposed to overcome the loss of antidepressant efficacy,
double-blind controlled studies are needed to ascertain the
optimal strategy for this perplexing clinical problem.