New Treatment Strategy For The Prevention Of Recurrent Depression

Major depressive disorder is a recurrent condition that can have a profound impact on an individual's quality of life. In the United States, approximately 17 percent of individuals will experience major depressive disorder during their lifetime.

Of those who experience one episode of major depression, more than 50 percent will have a recurrence. After two episodes, more than 70 percent of patients will have a recurrence, and after three episodes that figure jumps 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.

In the November issue of the Journal of Clinical Psychiatry, Susan G. Kornstein, M.D., a professor of psychiatry and obstetrics and gynecology in VCU's School of Medicine and lead author on the study, reported with her colleagues that maintenance treatment with escitalopram, a selective serotonin reuptake inhibitor (SSRI) approved for the treatment of depression, may reduce the risk of recurrent depression in patients with major depressive disorder.

Between 2000 and 2003, researchers evaluated approximately 200 participants at 28 centers in the United States who had responded positively to eight weeks of treatment with one of four different SSRIs: fluoxetine, sertraline, paroxetine or citalopram. This was followed by four months of treatment with escitalopram. These participants were then randomly assigned to fixed-dose treatment with 10 or 20 mg of 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." The medication was found to be safe and well tolerated throughout the study, she said.

"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," she said.

This work was funded by Forest Research Institute.

Kornstein is also the executive director of VCU's Mood Disorders Institute and VCU's Institute for Women's Health, designated a National Center of Excellence by the U.S. Department of Health and Human Services. She collaborated on the study with Anjana Bose, Ph.D., Dayong Li, Ph.D., Khalil G. Saikali, Ph.D., and Chetan Gandhi, Ph.D., who are researchers with Forest Research Institute.