Hirschfeld R M, Schatzberg A F
Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Galveston 77555.
Am J Med. 1994 Dec 19;97(6A):33S-38S. doi: 10.1016/0002-9343(94)90361-1.
Major depression is often a chronic and recurrent disorder. Findings from a landmark study, the Pittsburgh Study of Maintenance Therapies in Recurrent Depression, demonstrate that full doses of antidepressants prevent recurrent depression and that maintenance therapy lasting at least 5 years may be required for patients with severely recurrent disease. In addition, psychotherapy is a useful adjunct to antidepressant maintenance therapy in prolonging the duration between recurrent episodes. The currently accepted approach to preventing recurrent depression is to treat the acute episode to full remission and follow up by maintaining the patient on the full, acute dose used to achieve the initial response. The selective serotonin reuptake inhibitors (SSRIs) have been studied in recurrent depression and are rational choices for initial maintenance therapy because of demonstrated efficacy, safety, and tolerance during long-term therapy.
重度抑郁症通常是一种慢性复发性疾病。一项具有里程碑意义的研究——匹兹堡复发性抑郁症维持治疗研究——的结果表明，足量的抗抑郁药可预防复发性抑郁症，对于严重复发性疾病的患者可能需要持续至少5年的维持治疗。此外，心理治疗作为抗抑郁维持治疗的辅助手段，在延长复发发作间隔时间方面很有用。目前公认的预防复发性抑郁症的方法是将急性发作治疗至完全缓解，然后让患者维持使用达到初始缓解所用的足量急性剂量进行随访。选择性5-羟色胺再摄取抑制剂（SSRI）已在复发性抑郁症中进行了研究，由于其在长期治疗中已证实的疗效、安全性和耐受性，是初始维持治疗的合理选择。
