Long-term depression: practical concepts of classification and management

Abstract

In the long-term management of depression is necessary to take into account some key concepts: evolutive characteristics of depressive episodes, first clinical episode onset, number of episodes, duration, intervals and cycles, course of illness, etc. Long-term treatment is a broad term that would include the treatment or therapeutic strategy used once the acute treatment is over. It has been divided into continuation or consolidation treatment and maintenance or prophylactic treatment. Conceptually, other terms and definitions are relevant: partial remission implies a depressive symptomatology without criteria for a complete episode or syndrome. Response may be considered once partial remission has begun. Partial remission may be spontaneous, though there is a trend to assume that is secondary to the study drug’s effectiveness. The absence of evolution of partial to total remission creates the need to test new therapeutic strategies. Residual symptoms are the first step to more severe ones such as episodic relapse and chronicity. «Residual symptomatology» is associated in literature with a higher rate of relapses. Full remission implies lack of significant depressive symptoms for a determined period of time (at least 2 months). Recovery is a continuum between absence of depressive symptoms and mild or moderate symptoms. Relapse is defined by a clinical episode at least 6 months after the previous one and recurrence over 6 months.