Preventing Recurrent Depression: Long-Term Treatment for Major Depressive Disorder

Pierre Blier, M.D., Ph.D.; Martin B. Keller, M.D.; Mark H. Pollack, M.D.; Michael E. Thase, M.D.; John M. Zajecka, M.D.; and David L. Dunner, M.D., Chair

In contrast to continuation therapy, a treatment aimed at suppressing symptoms during a current depressive episode, maintenance therapy is designed to prevent the development of a new episode. Candidates for maintenance therapy include patients who have achieved remission and have had 2 or more lifetime episodes, especially if they have comorbid disorders, ongoing psychosocial stressors, poor symptom control, or severe depressive episodes. Maintenance pharmacotherapy data strongly support the use of antidepressants at the dosage that helped the patient achieve remission. Other maintenance treatment interventions include psychotherapy, especially cognitive-behavioral therapy, and in some extreme cases, electroconvulsive therapy. Maintenance therapy considerations for clinicians include assessing treatment guidelines, addressing nonadherent patients, and measuring medication treatment response.

(J Clin Psychiatry 2007;68(3):e06)

From the Department of Psychiatry and the Department of Cellular Molecular Medicine, Institute of Mental Health Research, University of Ottawa, and the Mood Disorders Research Program, Royal Ottawa Hospital, Ontario, Canada (Dr. Blier); the Department of Psychiatry and Human Behavior, Brown University School of Medicine and Butler Hospital, Providence, Rhode Island (Dr. Keller); the Department of Psychiatry, Harvard Medical School, and the Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital, Boston (Dr. Pollack); the Department of Psychiatry, University of Pittsburgh School of Medicine and the Western Psychiatric Institute and Clinic, Pittsburgh, Pa. (Dr. Thase); the Department of Psychiatry and the Woman’s Board Depression Treatment & Research Center, Rush University Medical Center, Chicago, Ill. (Dr. Zajecka); and the Center for Anxiety and Depression and the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Dr. Dunner).