LONG-TERM TREATMENT OF DEPRESSION

In the late 1800's Kraepelin hypothesized that depression had a high probability for recovery. He described depression as acute episodes from which the patient returned to premorbid state of ''well-being''. It was postulated that there were subgroups who had a recurrent course, but the emphasis was on the theory that between episodes of depression, individuals would exhibit minimal symptomatology and would return to their usual level of social and work functioning. Until the late 1970s, this outcome characteristic was one of the ways that depression was differentiated from schizophrenia, in which the course of illness was observed to be chronic and unremitting (1). For over a decade research and clinical observation have shown that patients with depression have a significant likelihood of experiencing relapse, recurrence, chronicity, and residual ''subsyndromal'' symptoms between full-criteria episodes of illness. In addition, depression is one of the most common psychiatric illnesses. Data gathered by the Epidemiological Catchment Area Study indicated a 8% lifetime prevalence for depression in its general population sample (2). Death from suicide is markedly increased among depressed individuals and the risk of death by suicide is 15% for people hospitalized for depression (3,4,5,6). It is, therefore, of great importance that all physicians be made aware of the risk that major depression may become chronic and/or recurrent, and of the need to continue to treat patients with this disorder even when symptoms have abated to subsyndromal levels, and to also consider maintenance treatment after full recovery.