Antidepressants in long-term therapy: A review of tricyclic antidepressants and selective serotonin reuptake inhibitors

Objective: Although depression has been shown to be a long-term disorder, most research studies have concentrated on its acute treatment. Method: A literature review of the use of tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) in long-term treatment of depression was performed and recommendations regarding long-term treatment were summarized. Results: Studies conclusively document the need for continuation treatment after initial remission of symptoms to prevent relapse. Studies also suggest that continuation treatment should last a minimum of 3-6 months following acute response. Conclusions from a few maintenance studies clearly show that recurrence rates are lower when patients at risk for recurrence continue their active treatment at its original dose than when they are switched to placebo. Conclusion: Overall, studies conclude that depression is a recurrent, often chronic, lifetime illness requiring long-term treatment. Continuation therapy of 3 to 6 months after acute stabilization should be considered standard for all depressed patients, and maintenance therapy should be considered for many depressed patients. Newer agents, such as the SSRIs, are preferable to the TCAs for long-term treatment based on their superior tolerability and safety. However, because of the limited number of maintenance studies, further studies using a prospective, randomized design are needed to address this issue.