Abstract
Clinical research has established that depression is frequently a recurrent disorder;1-3 50% of persons who have one episode of major depression will have a second, and 80-90% of those with a second will have a third.4 Bolstered by the testimony of leading experts on affective disorders, recent media attention has been aimed at emphasizing depression as a long-term illness with biological underpinnings in an attempt to remove the stigma attached to the disorder among the general public. Nonetheless, clinicians not uncommonly approach the treatment of depression as though the disorder were only a short-term, episodic illness, employing long-term maintenance strategies as the exception rather than the rule. Beyond the danger of relapse inherent in discontinuing treatment is the suggestion that clinicians may unwittingly contribute to the poor prognosis of their recurrently depressed patients by interrupting treatment or by lowering medication doses to subtherapeutic levels following response.5