from: http://www.arizonarepublic.com/news/articles/0221antidepressants21.html
Antidepressants needed long-term, study suggests
By Emma Ross
Associated Press
Feb. 21, 2003
Most patients treated for depression should remain on medication after their gloom has lifted, new research suggests.
Over the past decade, scientists have discovered that depression, which plagues millions, recurs repeatedly in four out of five patients. However, it is still mostly tackled as an episode, and drugs are usually prescribed for no more than two or three months.
A comprehensive review of 30 years of evidence, published this week in the Lancet medical journal, suggests that is the wrong approach. In the analysis, those who stayed on antidepressants were half as likely to have another bout of depression as those who stopped taking medication.
"Everybody thinks that when their symptoms are under control they can withdraw the treatment," said one researcher, Dr. David Kupfer. "It looks like the people who need medication to get better need it to stay better."
The Lancet researchers combined the information from 31 studies conducted over the past 30 years on patients with recurrent bouts of depression. The patients had done well on short-term antidepressant therapy and then were randomly assigned either continued drug treatment or fake pills.
The studies involved a total of 4,410 patients. Most of the studies followed patients for a year, some for three years. The studies examined a wide range of antidepressants.
Only 18 percent of those who stayed on their drugs relapsed during the study period, compared with 41 percent of those who discontinued their medication.
The type of antidepressant did not seem to matter.
"This calls for a clear recognition that you need to think about this as a chronic recurrent disease, and it's the same way you would treat hypertension, diabetes or chronic asthma," said Kupfer, chairman of psychiatry at the University of Pittsburgh Medical Center.
Although experts differ on whether depression turns recurrent after two episodes or three, they agree that long-term treatment is not necessarily appropriate after a single bout of depression.
And not all depression requires drugs. Mild to moderate depression can be treated by psychotherapy, experts say. But when the condition is severe, such as when there are suicidal thoughts, medication is needed.