Volume 178 - Issue 10
In reply: How long should drug treatment of depression last?
Author: Pete M Ellis
Med J Aust 2003; 178 (10): 526-527. || doi: 10.5694/j.1326-5377.2003.tb05341.x
Published online: 19 May 2003
Published online: 19 May 2003
In reply: Fava observes that duration of treatment with an antidepressant does not affect the subsequent rate of relapse. Indeed, it would be unexpected if it did; medication only works while it is being taken. He then states that the duration of antidepressant treatment is immaterial. However, Figure 1 of the reference he quotes1 indicates that, for at least 54 months after the index episode, continuing medication provides greater protection against relapse than early discontinuation.
This argues strongly for the beneficial effects of continuing antidepressant therapy for a significant period after recovery. The duration of this period depends on the number of previous episodes of depression and is a compromise between the benefits of effective prophylaxis and the burden of treatment.
He also refers to a study of "tolerance" to 20 mg fluoxetine.2 Of patients who responded to treatment, 31.4% relapsed while on maintenance treatment. Of these, 57% responded to an increase to 40 mg fluoxetine and remained well for six months. He appears to have interpreted these data differently.
I agree that treating depression involves more than prescribing. The beyondblue guidelines promote active collaboration with the depressed person in addressing key issues in their lives and a focus on relapse prevention.3 Cognitive behavioural therapy is one strategy for achieving this.
References
- Viguera AC, Baldessarini RJ, Friedberg J. Discontinuing antidepressant treatment in major depression. Harv Rev Psychiatry 1998; 5: 293-306.
- Baldessarini RJ, Ghaemi SN, Viguera AC. Tolerance in antidepressant treatment. Psychother Psychosom 2002; 71: 177-179. 2
- Ellis PM, Smith DAR. Treating depression: the beyondblue guidelines for treating depression in primary care. Med J Aust 2002; 176 (Suppl 20 May): S77-S83. 3
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