Many patients who have had a recurrence of major depression may benefit from long-term maintenance antidepressant therapy, according to an article in the November issue of the Journal of Clinical Psychiatry.

According to the authors, more than 50 percent of people who have one episode of major depression will have a recurrence. After two episodes, more than 70 percent of patients will have another recurrence; after three episodes, the risk for recurrence increases to 90 percent. Each episode poses a new risk that the depression may not respond to treatment, making prevention of recurrent depression an important focus of long-term treatment.

Between 2000 and 2003, American researchers led by Susan G. Kornstein, MD, evaluated approximately 200 participants at 28 centers who had responded positively to eight weeks of treatment with one of four different agents: fluoxetine, sertraline, paroxetine, or citalopram. Initial therapy was followed by four months of treatment with escitalopram. Participants were then randomized to fixed-dose treatment with 10 or 20 mg escitalopram or placebo for one year.

“Patients who were switched to placebo showed a significantly higher rate of depression recurrence (65 percent) compared to those who stayed on escitalopram (27 percent),” said Kornstein. “This was true even though the patients showed a full resolution of their depression at the start of maintenance treatment. These findings indicate the importance of maintenance therapy for patients with recurrent major depressive disorder beyond four to six months of improvement, even if a patient’s depressive symptoms appear to be resolved.”

The medication was found to be safe and well tolerated throughout the study, she added .