Psychiatria pre prax 2/2001

Principles of long-term treatment of depression

The significance of long-term treatment of depression has been rising in the past years, as it became known that repeated depressive phases aggravate the prognosis of the disease. Normally, once the acute symptoms have receded, a distinction is made between continuing treatment and maintenance treatment; but in both phases the dosage of antidepressants remains the same as for acute treatment. A subgroup of depressive patients may achieve progress by taking a placebo in the acute phase of the treatment; however this effect is not persistent during maintenance treatment. In long-term therapy, however, the approach varies depending on the type of depression. With bipolar affective disorders, thymoleptics are the treatment of choice and antidepressants are inappropriate. With unipolar disorders lithium and antidepressants are equally effective. Because of the low incidence of their side effects, third-and fourth-generation antidepressants are given priority over other antidepressants and lithium. The significance of psychotherapy in the long-term treatment of depression has not been sufficiently studied. It seems to be applicable chiefly to slight depressions with a normal slow-wave sleep EEG.

Keywords: long-term treatment of depression, unipolar depression, bipolar affective disorder, antidepressants, thymoprophylactics, psychotherapy, placebo responders.