Depression long-term outcomes

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It should be noted that these clinical trials are typically conducted within a short time period and thus may not reflect long-term outcomes. The utility of St. John s wort in the treatment of moderate to severe depression has been investigated (14-17) in large randomized placebo-controlled multi-institutional studies. Some such studies demonstrated efficacy (16), but others failed to detect a clinically significant effect on the symptoms of the moderate to severely depressed individuals (15,17). Gelenberg et al. demonstrated a relapse rate of approximately 30% in moderate to severely depressed individuals who initially responded to St. John s wort therapy as would be expected from experience with prescription antidepressants (14). 

Holma KM et al Long-term outcome of major depressive disorder in psychiatric patients is variable. J Clin Psychiatry 2008 69(2) 196. [PMID 18251627]... 

One can look at the effects of antidepressant treatments on the long-term outcome from depression as either good news or bad news, depending on whether it is seen from the perspective of response or from the perspective of remission. The news looks good if mere response to an antidepressant is the standard (i.e., getting better), but if one raises the bar and asks about remission (i.e., getting well), the news does not look nearly as good (Tables 5—12 and 5—13). 

The mood stabilizer lithium was developed as the first treatment for bipolar disorder. It has definitely modified the long-term outcome of bipolar disorder because it not only treats acute episodes of mania, but it is the first psychotropic drug proven to have a prophylactic effect in preventing future episodes of illness. Lithium even treats depression in bipolar patients, although it is not so clear that it is a powerful antidepressant for unipolar depression. Nevertheless, it is used to augment antidepressants for treating resistant cases of unipolar depression. 

Hatzinger M, Hemmeter UM, Brand S, Ising M, Holsboer-Trachsler E (2004) Electroencephalographic sleep EEG profiles in treatment course and long-term outcome of major depression association with DEX/CRH-test response. J Psychiatr Res 38 453M65... 

Liebowitz MR, Heimberg RG, Schneir FR, et al. Cognitive-behavioral group therapy versus phenelzine in social phobia Long term outcome. Depress Anxiety 1999 10 89-98. 

The desired outcomes of treatment of GAD are to reduce severity, duration, and frequency of the symptoms and to improve overall functioning. The long-term goal is minimal or no anxiety or depressive symptoms, no functional impairment, and improved quality of life. 

Many patients are treatment-refractory the percentage of patients who are nonresponders and who have a very poor outcome during long-term follow-up evaluation after a diagnosis of depression is disappointingly high, up to 20%. 

Antidepressants modify the long-term course of bipolar disorder as well. When given with lithium or other mood stabilizers, they may reduce depressive episodes. Interestingly, however, antidepressants can flip a depressed bipolar patient into mania, into mixed mania with depression, or into chaotic rapid cycling every few days or hours, especially in the absence of mood stabilizers. Thus, many patients with bipolar disorders require clever mixing of mood stabilizers and antidepressants, or even avoidance of antidepressants, in order to attain the best outcome. 

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