[Efficacy of antidepressants and thymoregulators in the long-term evolution of depression].

Official recommendations pointed out the long term maintenance treatment of recurrent unipolar depression on the basis of a significant effect of antidepressants and mood-stabilizers versus placebo. The results of controlled studies, mainly using imipramine or lithium salts, have not been encouraging in term of long term prognosis, due to the limited success rate for maintenance phase ranging from 30 to 48%. The "Pittsburgh study" maximized the recurrence potential by defining patients selection on at least 3 previous episodes of unipolar depression, with the immediate previous episode being no more than 2.5 years earlier, beginning the experimental maintenance therapy phase after patients remain relatively symptom free for a total of 20 weeks, and scheduled the imipramine withdrawal in the randomly assigned placebo group by a progressive reduction of 33% per week. Survival analysis in the 5 years maintenance outcome of previously imipramine responders patients demonstrated an increased risk of depressive recurrence at the beginning of discontinuation but did not prove a true prophylactic effect. Furthermore these findings do not prove that treatment are not more effective than placebo, suggesting at least a revisitation of the clinical concept of response. The putative efficacy of biological treatment should be an operational criteria to elicit vulnerability markers, mainly in the field of sleep research.