Clinical Issues in Long-Term Treatment With Antidepressants

Historically, the emphasis in treating depression has been focused on the acute phase of treatment,with few published data on the continuation and maintenance phases of treatment. Yet the risk of depressionincreases with each episode, with a 50% to 90% chance of developing another episode after 1or 2 prior episodes of depression. Moreover, subsequent episodes of depression are often of longerduration, more severe, and less responsive to treatment. Most patients with major depression requiresome form of long-term antidepressant treatment, and many need lifelong treatment. Optimizing efficacyand minimizing side effects are essential during both the acute and long-term phases of antidepressanttreatment. Antidepressant side effects, including insomnia or somnolence, weight gain,asthenia, and sexual dysfunction, can significantly decrease patient compliance with long-term treatmentfor depression. Identification and management of side effects, combined with early and ongoingeducational messages to the patient about treatment issues and the importance of sustaining illnessremission, help improve compliance and reduce the potential for premature discontinuation of anotherwise optimal antidepressant.