Depressive breakthrough

Patients with major depression tend to have multiple episodes. Episodes that redevelop within 6 months of acute response are called relapses, whereas those that occur after 6 months are called recurrences.(17) Theoretically, relapses are considered a return of the original episode, whereas recurrences represent a new episode; but these are hypotheses without any substantiating data. Without long-term antidepressant treatment, depressive relapses or recurrences occur in 50% to 80% of patients.(11,17,23,26,38) Double-blind, discontinuation studies reveal that antidepressants decrease the risk for relapse and recurrence and have repeatedly been shown antidepressants to be more efficacious than placebo substitution.(11,16,30,42,48) Nonetheless, observational studies have shown that, within 1 to 5 years after an acute response, 20% to 80% of patients develop another depressive episode even while taking longterm antidepressants for prophylaxis.(27,30,36,40) A succinct term for relapse or recurrence during long-term antidepressant treatment is depressive breakthrough. Several case series and only a few controlled studies have described the return of major depression during: long-term antidepressant therapy, but fewer studies have examined the management of patients who have depressive breakthrough. With increasing emphasis on long-term treatment of chronic relapsing and recurring depressive disorders, and the dramatic increase in the number of patients who use selective serotonin reuptake inhibitor (SSRI) antidepressant therapy within the past 5 years, the treatment of depressive breakthrough must be improved.