Factors Affecting Return of Symptoms 1 Year After Treatment in a 62-Week Controlled Study of Fluoxetine in Major Depression

Background: In spite of impressive results in acute studies, the long-term treatment of major depression remains problematic. To explore the return of depressive symptoms and their interaction withsocial factors on long-term outcome, we assessed 55 patients whose depression had been treated duringa 62-week, fluoxetine maintenance study, 1 year after the study’s termination. Method: During the year following the study termination, patients were free to select treatment options. Assessments atthe 1-year follow-up included measures of depressive symptoms (using the Hamilton Rating Scale forDepression [HAM-D]), social and marital impairment (using the Weissman Social Adjustment Scale[SAS]), personal stressors (using the Holmes Social Readjustment Rating Scale), and history of treatmentduring the past year. Results: At the time of the naturalistic follow-up, 53% of patients sustained their improvement in mood. Factors associated with return of depressive symptoms included personalstresses, marital maladjustment, personal decision to discontinue antidepressants, and medication failure.Psychosocial variables were associated with poor outcome in over 90% of impaired subjects. Developmentof subsyndromal symptoms during the 50-week double-blind phase was predictive of pooreroutcome at the long-term follow-up. Conclusion: The study demonstrates that no matter how effective initial pharmacologic therapy may be, without ongoing clinical monitoring and support, particularlyin dealing with issues such as marriage and handling significant life stresses, and compliancewith medications, it will not be successful in the long-term treatment for a significant portion of patientswith depression.