Tratamiento de mantenimientola clave del éxito en la terapia de las depresiones

Resumen

Depressive disorders can be recurrent or chronic and constitute a heavy health and social burden. In the long term 75-80% of patients are estimated to experience recurrence. The factors associated with the risk of recurrence are a large number of previous episodes, a short interval between episodes, a familial history of depression, advanced age, concomitant somatic disease, and poor treatment compliance. Currently, the main aim of therapy is that patients do not abandon treatment when stabilization has been achieved. It is estimated that 30-40% of patients withdraw from treatment in the first few weeks and nearly 60% discontinue maintenance therapy, against physician advice. Several measures to improve adherence have been proposed, such as using drugs that are better tolerated, simple treatment regimens, family help, reminder systems, education, etc. Most antidepressants can be used in the long term but experience with selective serotonin reuptake inhibitors (SSRI) is broader and more reliable than that with other drugs. The use of prolonged action drugs, which require fewer doses, is important and in this context, experience with weekly dosing schedules of fluoxetine are highly encouraging with medium- and long-term compliance rates of 80-90%. Because treatment discontinuation is the primary cause of recurrence in many recurrent and chronic disorders, with serious health and social repercussions, long-term maintenance therapy should be encouraged and facilitated. To do this, safe and effective drugs in are simple and easy to administer are essential.