Long-term pharmacotherapy for unipolar affective disorder.

Unipolar affective disorders are highly recurrent. Indicators of risk for recurrence can be established for the individual patient. These may include severity of episode, number of episodes, older age of onset, and preexisting other psychiatric conditions. The continuation treatment phase is necessary for all patients with depression in order to prevent relapse or breakthrough symptoms. Preventative treatment should be offered for the patients at risk for recurrences. The drugs in the continuation phase are usually the same ones used to treat the acute phase. The dose should be very gradually decreased while the patient is closely monitored. The choice of drug is also a matter of individual choice, though some general guidelines are available. For example, for a patient who is clearly unipolar and whose index episode is severe, an antidepressant may be preferable to lithium.