Preventing recurrent depression: long-term treatment for major depressive disorder.

In contrast to continuation therapy, a treatment aimed at suppressing symptoms during a current depressive episode, maintenance therapy is designed to prevent the development of a new episode. Candidates for maintenance therapy include patients who have achieved remission and have had 2 or more lifetime episodes, especially if they have comorbid disorders, ongoing psychosocial stressors, poor symptom control, or severe depressive episodes. Maintenance pharmacotherapy data strongly support the use of antidepressants at the dosage that helped the patient achieve remission. Other maintenance treatment interventions include psychotherapy, especially cognitive-behavioral therapy, and in some extreme cases, electroconvulsive therapy. Maintenance therapy considerations for clinicians include assessing treatment guidelines, addressing nonadherent patients, and measuring medication treatment response.