Hostname: page-component-586b7cd67f-tf8b9 Total loading time: 0 Render date: 2024-11-22T07:16:24.782Z Has data issue: false hasContentIssue false
  • English
  • Français

Initial Effectiveness, Partial Remission, and Full Remission in Depression: Focus on Long-Term Treatment with SNRIs

Published online by Cambridge University Press:  07 November 2014

Serdar Dursun
Get access Rights & Permissions [Opens in a new window]

Abstract

Full remission, defined as the absence of all significant symptoms of depression over at least 6 months, is the ultimate goal of antidepressant therapy. Remission takes time and studies have shown that remission rates continue to rise for at least 3 months after initial improvement. Depression is a recurrent condition with a cumulative probability of recurrence of 40% over 2 years and 70% over 5 years after the first depressive episode. In addition the risk of recurrence increases with each new depressive episode. Continuing antidepressant treatment beyond the acute response significantly decreases the risk of recurrence. A double-blind study with the serotonin norepinephrine reuptake inhibitor milnacipran, for example, has shown that patients in remission following treatment with milnacipran who continued the active treatment for a further 12 months had significantly less relapse (P<.05) than those switched to placebo. In spite of the importance of maintaining antidepressant therapy, many patients do not continue treatment. Among the principal reasons for this are side effects and worries of psychological or physical dependence. To reduce the risk of relapse, treatment with effective, well-tolerated antidepressants with few withdrawal effects should be pursued for at least 6 months and possibly longer in patients already experiencing relapse.

Type
Research Article
Information
CNS Spectrums , Volume 13 , supplement S11 , July 2008 , pp. 10 - 14
Copyright
Copyright © Cambridge University Press 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Trivedi, MH, Lin, EH, Katon, WJ. Consensus recommendations for improving adherence, self-management, and outcomes in patients with depression. CNS Spectr. 2007;12(8 Suppl 13):1–27.Google Scholar
2. Chehil, S, Devarajan, S, Dursun, SM. Pharmacologic management of refractory depression. Can Fam Physician. 2001;47:50–52.Google Scholar
3. Mahli, GS, Bridges, PK. Management of Depression. London: Martin Dunitz; 1998.Google Scholar
4. Hawley, CJ, Gale, TM, Sivakumaran, T, Hertfordshire Neuroscience Research group. Defining remission by cut off score on the MADRS: selecting the optimal value. J Affect Disord. 2002;72:177–184.Google Scholar
5. Zimmerman, M, Posternak, MA, Chelminski, I. Derivation of a definition of remission on the Montgomery-Asberg depression rating scale corresponding to the definition of remission on the Hamilton rating scale for depression. J Psychiatr Res. 2004;38:577–582.CrossRefGoogle Scholar
6. Paykel, ES, Ramana, R, Cooper, Z, Hayhurst, H, Kerr, J, Barocka, A. Residual symptoms after partial remission: an important outcome in depression. Psychol Med. 1995;25:1171–1180.Google Scholar
7. Thase, ME, Entsuah, AR, Rudolph, RL. Remission rates during treatment with venlafaxine or selective serotonin reuptake inhibitors. Br J Psychiatry. 2001;178:234–241.CrossRefGoogle ScholarPubMed
8. IM, Anderson. Meta-analytical studies on new antidepressants. Br Med Bull. 2001;57:161–178.Google Scholar
9. Papakostas, GI, Thase, ME, Fava, M, Nelson, JC, Shelton, RC. Are antidepressant drugs that combine serotonergic and noradrenergic mechanisms of action more effective than the selective serotonin reuptake inhibitors in treating major depressive disorder? A meta-analysis of studies of newer agents. Biol Psychiatry. 2007;62:1217–1227.Google Scholar
10. Montgomery, SA, Baldwin, DS, Blier, P, et al. Which antidepressants have demonstrated superior efficacy? A review of the evidence. Int Clin Psychopharmacol. 2007;22:323–329.Google Scholar
11. Papakostas, GI, Shelton, RC, Smith, J, Fava, M. Augmentation of antidepressants with atypical antipsychotic medications for treatment-resistant major depressive disorder: a meta-analysis. J Clin Psychiatry. 2007;68:826–831.Google Scholar
12. Philip, NS, Carpenter, LL, Tyrka, AR, Price, LH. Augmentation of antidepressants with atypical antipsychotics: a review of the current literature. J Psychiatr Pract. 2008;14:34–44.Google Scholar
13. Solomon, DA, Keller, MB, Leon, AC, et al. Multiple recurrences of major depressive disorder. Am J Psychiatry. 2000;157:229–233.CrossRefGoogle ScholarPubMed
14. Solomon, DA, Bauer, MS. Continuation and maintenance pharmacotherapy for unipolar and bipolar mood disorders. Psychiatr Clin North Am. 1993;16:515–540.Google Scholar
15. Frank, E, Kupfer, DJ, Perel, JM, et al. Comparison of full-dose versus half-dose pharmacotherapy in the maintenance treatment of recurrent depression. J Affect Disord. 1993;27:139–145.Google Scholar
16. Papakostas, GI, Perlis, RH, Seifert, C, Fava, M. Antidepressant dose reduction and the risk of relapse in major depressive disorder. Psychother Psychosom. 2007;76:266–270.Google Scholar
17. Rouillon, F, Warner, B, Pezous, N, Bisserbe, JC. Milnacipran efficacy in the prevention of recurrent depression: a 12-month placebo-controlled study. Milnacipran recurrence prevention study group. Int Clin Psychopharmacol. 2000;15:133–140.CrossRefGoogle ScholarPubMed
18. Vallejo Ruiloba, J. Current situation of long-term treatment of depression. Actas Esp Psiquiatr. 2007;35:285–299.Google Scholar
19. Keller, MB, Trivedi, MH, Thase, ME, et al. The Prevention of Recurrent Episodes of Depression with Venlafaxine for Two Years (PREVENT) Study: Outcomes from the 2-year and combined maintenance phases. J Clin Psychiatry. 2007;68:1246–1256.CrossRefGoogle ScholarPubMed
20. Perahia, DG, Gilaberte, I, Wang, F, et al. Duloxetine in the prevention of relapse of major depressive disorder: double-blind placebo-controlled study. Br J Psychiatry. 2006;188:346–353.CrossRefGoogle ScholarPubMed
21. Bockting, CL, ten Doesschate, MC, Spijker, J, Spinhoven, P, Koeter, MW, Schene, AH, DELTA study group. Continuation and maintenance use of antidepressants in recurrent depression. Psychother Psychosom. 2008;77:17–26.Google Scholar