Long-term treatments of recurrent depressive disorders.

Many, if not most, depressive disorders become recurrent conditions. It is now clear that virtually all recently remitted patients should receive 4 to 6 months of continuation therapy. Moreover, this phase of treatment should continue until the patient has achieved a clear-cut, durable period of recovery. Further, an extended course of maintenance pharmacotherapy is recommended for those patients at risk for subsequent recurrent episodes. In this paper, the rationale for long-term treatment is presented and common strategies are reviewed. Depressive disorders appear to become more autonomous, severe, and potentially refractory with each new episode. Thus, prevention of recurrent depression remains the best available strategy to ensure an optimal long-term outcome for patients with recurrent affective disorders.