Can long-term treatment with antidepressant drugs worsen the course of depression?

@article{Fava2003CanLT,
  title={Can long-term treatment with antidepressant drugs worsen the course of depression?},
  author={Giovanni Andrea Fava},
  journal={The Journal of clinical psychiatry},
  year={2003},
  volume={64 2},
  pages={
          123-33
        }
}
  • G. Fava
  • Published 1 February 2003
  • Psychology, Medicine
  • The Journal of clinical psychiatry
BACKGROUND The possibility that antidepressant drugs, while effectively treating depression, may worsen its course has received inadequate attention. METHOD A review of the literature suggesting potential depressogenic effects of long-term treatment with antidepressant drugs was performed. A MEDLINE search was conducted using the keywords tolerance, sensitization, antidepressive agents, and switching. This was supplemented by a manual search of Index Medicus under the heading "antidepressant… 

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References

SHOWING 1-10 OF 136 REFERENCES

Potential Sensitising Effects of Antidepressant Drugs on Depression

The possibility that antidepressant drugs, while effectively treating depression in the short term, may worsen its course through a sensitisation process has been proposed. Although this hypothesis

Tolerance in Antidepressant Treatment

TLDR
Observations are provided from their long-term collaborative study of outpatients with moderately severe, recurrent unipolar depression who relapsed during longterm treatment with (B)-fluoxetine, extending previous observations that increasing fluoxettine doses can rescue some late failures.

Loss of antidepressant efficacy during maintenance therapy: possible mechanisms and treatments.

TLDR
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.

Treatment approaches to major depressive disorder relapse. Part 2: reinitiation of antidepressant treatment.

TLDR
The results challenge the view that the efficacy of an agent prematurely discontinued is diminished when such an agent is restarted and generally support reinitiation of the same antidepressant as a 'first-line' treatment strategy in patients who relapsed after stopping a previously effective antidepressant.

Treatment approaches to major depressive disorder relapse. Part 1: dose increase.

TLDR
The patients relapsing after initially responding to fluoxetine can benefit from an increase in fluoxettine dose, and results generally support increasing dose as a first-line treatment strategy for a patient who has relapsed while taking a previously effective dose of an antidepressant.

Cognitive-behavioral management of drug-resistant major depressive disorder.

BACKGROUND The application of cognitive-behavioral treatment to drug-resistant major depression has received little research attention. METHOD Nineteen patients who failed to respond to at least

Treatment Approaches to Major Depressive Disorder Relapse

TLDR
The results challenge the view that the efficacy of an agent prematurely discontinued is diminished when such an agent is restarted and generally support reinitiation of the same antidepressant as a ‘first-line’ treatment strategy in patients who relapsed after stopping a previously effective antidepressant.

Discontinuing Antidepressant Treatment in Major Depression

TLDR
Compared with patients whose antidepressants were discontinued, those with continued treatment showed much lower relapse rates, and differences in relapses off versus on antidepressants fell markedly with longer follow‐up, but gradual discontinuation (dose‐tapering or use of long‐acting agents) did not yield lower relapse rate.

Emergence of depressive symptoms during treatment for panic disorder with specific 5‐hydroxytryptophan reuptake inhibitors

TLDR
There is a vulnerability among some of panic disorder patients to noradrenergic‐serotonergic imbalance caused by SSRI, which has to be taken into clinical consideration.
...