Abstract
Background:
Many patients with unipolar depression experience a return of depressive symptoms while taking a constant maintenance dose of an antidepressant.
Method:
All cited studies were found using computerized literature searches of the MEDLINE database since 1966.
Results:
The return of depressive symptoms during maintenance antidepressant treatment has occurred in 9% to 57% of patients in published trials. Possible explanations include loss of placebo effect, pharmacologic tolerance, increase in disease severity, change in disease pathogenesis, the accumulation of a detrimental metabolite, unrecognized rapid cycling, and prophylactic inefficacy.
Conclusion:
Although several strategies have been proposed to overcome the loss of antidepressant efficacy, double-blind controlled studies are needed to ascertain the optimal strategy for this perplexing clinical problem.
Publication types
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Research Support, Non-U.S. Gov't
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Research Support, U.S. Gov't, P.H.S.
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Review
MeSH terms
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Adult
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Aged
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Antidepressive Agents / pharmacokinetics
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Antidepressive Agents / therapeutic use*
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Antidepressive Agents, Tricyclic / pharmacokinetics
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Antidepressive Agents, Tricyclic / therapeutic use
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Clinical Trials as Topic
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Depressive Disorder / drug therapy
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Depressive Disorder / prevention & control*
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Depressive Disorder / psychology
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Dose-Response Relationship, Drug
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Drug Administration Schedule
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Drug Therapy, Combination
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Drug Tolerance
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Female
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Humans
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MEDLINE
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Male
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Middle Aged
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Monoamine Oxidase Inhibitors / pharmacokinetics
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Monoamine Oxidase Inhibitors / therapeutic use
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Placebo Effect
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Research Design
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Secondary Prevention
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Selective Serotonin Reuptake Inhibitors / pharmacokinetics
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Selective Serotonin Reuptake Inhibitors / therapeutic use
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Severity of Illness Index
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United States
Substances
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Antidepressive Agents
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Antidepressive Agents, Tricyclic
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Monoamine Oxidase Inhibitors
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Serotonin Uptake Inhibitors