Acute, continuation and maintenance phases of antidepressant treatment

Depression is a very prevalent disorder in general population characterized by recurrence and chronicity. The longitudinal studies conducted in the last 30 years described a picture consistent with a long-term illness requiring a life-long maintenance treatment. This paper is a review of the literature on clinical studies about antidepressant treatment, involving the 3 distinct treatment phases: acute, continuation, and maintenance or prophylaxis. The acute phase involves stabilization of acute symptoms and usually lasts 2 to 3 months. The purpose of the continuation phase is to prevent a relapse, and involves continuing medication for an additional 3 or 4 months. The discussed studies underline that an adequate duration of antidepressant therapy is correlated with improvement in symptomatology, the reduction of disabilities, the restoration of functioning and working performance and the prevention of relapse. This results in a substantial improvement in the patient's quality of life and in the achievement of considerable savings in the costs of the disorder. Effective clinical management is often a life-long task. In patients at higher risk for recurrences, prophylactic therapy is recommended, lasting for at least several years.