Management of recurrent depression.

Research completed over the past decade has established the chronic and recurrent nature of major depression. To date, treatment for the prevention of recurrence has promoted the use of "maintenance" doses of antidepressant medications that are lower than the effective for the acute phase of treatment. Long-term randomized, double-blind studies of tricyclic antidepressant (TCA) maintenance therapy have shown, however, that full-dose treatment strategy has a highly significant prophylactic effect in preventing a new episode of depression for up to 5 years. Monthly interpersonal psychotherapy has also been shown to have a modest but significant effect on survival. Although prophylaxis with full-dose TCAs can be well tolerated by patients when proper education and support are provided, newer antidepressant agents with milder side effect profiles are being studied for their efficacy in long-term management of depression. The results of 1-year studies of maintenance therapy with serotonin selective reuptake inhibiting agents suggest that these medications will play a major role in prophylaxis for recurrent depression.