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Abstract
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 1966.
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.
Comment in
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Can long-term antidepressant use be depressogenic?J Clin Psychiatry. 1999 Apr;60(4):263-4. doi: 10.4088/jcp.v60n0412e. J Clin Psychiatry. 1999. PMID: 10221291 No abstract available.
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Patient's coping skills and environmental stress important to understanding recurrence during antidepressant maintenance.J Clin Psychiatry. 1999 Aug;60(8):556. doi: 10.4088/jcp.v60n0809e. J Clin Psychiatry. 1999. PMID: 10485642 No abstract available.
Publication types
- Research Support, Non-U.S. Gov't
- Research Support, U.S. Gov't, P.H.S.
- Review
MeSH terms
- Adult
- Aged
- Antidepressive Agents / pharmacokinetics
- Antidepressive Agents / therapeutic use*
- Antidepressive Agents, Tricyclic / pharmacokinetics
- Antidepressive Agents, Tricyclic / therapeutic use
- Clinical Trials as Topic
- Depressive Disorder / drug therapy
- Depressive Disorder / prevention & control*
- Depressive Disorder / psychology
- Dose-Response Relationship, Drug
- Drug Administration Schedule
- Drug Therapy, Combination
- Drug Tolerance
- Female
- Humans
- MEDLINE
- Male
- Middle Aged
- Monoamine Oxidase Inhibitors / pharmacokinetics
- Monoamine Oxidase Inhibitors / therapeutic use
- Placebo Effect
- Research Design
- Secondary Prevention
- Selective Serotonin Reuptake Inhibitors / pharmacokinetics
- Selective Serotonin Reuptake Inhibitors / therapeutic use
- Severity of Illness Index
- United States
Substances
- Antidepressive Agents
- Antidepressive Agents, Tricyclic
- Monoamine Oxidase Inhibitors
- Selective Serotonin Reuptake Inhibitors
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