Reduction
of relapse rate by antidepressants used for a
long duration
It
is known that patients suffering from depression
are still at high risk of recurrence after 4 to
6 months of treatment. A systematic review of 31
randomised trials involving more than 4400
patients suffering from acute depressive
disorders, who had responded to a 4 to 6-month
standard treatment with antidepressants, was
recently undertaken. The subjects were assigned
to continue treatment or to placebo.
Continued antidepressant treatment for 1 to 2
years decreased the odds of relapse by about
66%. Patients who continued therapy had an
average relapse rate of 18% in comparison to 40%
for the placebo patients. The trials that were
analysed were mainly conducted in a secondary
care setting. Further long-term trials are
therefore needed in patients in primary care
with milder disease having a lower underlying
risk of relapse.
Since the major cost of depression are the
indirect costs such as loss of income due to
time off work long-term treatment should prove
to be very cost-effective estimated the
authors.
The reasons why patients do not take medications
for longer periods of time is currently being
investigated. The authors state that there is
popular miconception that long-term treatment
with antidepressants causes harm and can lead to
addiction. This belief needs to be publicly
compared to the clear evidence of the advantage
of long-term therapy.