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Relapse of Depressive Symptoms After Discontinuing Sertraline
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To the Editor: Dr Keller and colleagues1 report marked differences between continuing and discontinuing previously successful treatment with sertraline hydrochloride in patients with chronic depression. New episodes occurred in 10% of patients continuing sertraline (146 mg/d) for up to 18 months vs 30% after discontinuing sertraline and changing to placebo (over a period of 2.9 weeks), with new symptoms developing in 45% vs 72%, respectively. These differences (20%-27%) indicate a moderate sparing of relapse. It is remarkable that so many formerly long-term ill patients did so well after switching to placebo, but some may represent previously undertreated but reversible disorders.
The reported pattern of relapses is well-known in discontinuation trials, with a sharp, early separation of treated and discontinued patients, and little difference after the first few months.2-4 Computed rates (95% confidence interval [CI]) of return of depressive symptoms in weeks 1 to 24 were 1.91 (95% CI, 1.58-2.24) per . . . [Full Text of this Article]
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Maintenance Phase Efficacy of Sertraline for Chronic Depression: A Randomized Controlled Trial
Martin B. Keller, James H. Kocsis, Michael E. Thase, Alan J. Gelenberg, A. John Rush, Lorrin Koran, Alan Schatzberg, James Russell, Robert Hirschfeld, Daniel Klein, James P. McCullough, Jan A. Fawcett, Susan Kornstein, Lisa LaVange, Wilma Harrison, and for the Sertraline Chronic Depression Study Group
JAMA. 1998;280(19):1665-1672.
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