Chemotherapy in Psychiatry

The median time to a new episode with antidepressant treatment continued has averaged approximately 40 months, compared to just over 1 year if treatment was discontinued.

“The median time to a new episode with antidepressant treatment continued has averaged approximately 40 months, compared to just over 1 year if treatment was discontinued (Baldessarini, 2013; Rosenthal et al., 2013).”

Recurrence rates are over 85% within a decade of an index depressive episode, and average approximately 50% or more within six months of apparent clinical remission if the initially-effective treatment was not continued.

“Recurrence rates are over 85% within a decade of an index depressive episode, and average approximately 50% or more within six months of apparent clinical remission if the initially-effective treatment was not continued (Baldessarini, 2013).”

Currently, pharmacological and non-pharmacological treatments are relatively well established as having at least moderate efficacy for the short-term treatment of acute major depression.

“Currently, pharmacological and non-pharmacological treatments are relatively well established as having at least moderate efficacy for the short-term treatment of acute major depression (Undurraga and Baldessarini, 2012; Baldessarini, 2013; Bauer et al., 2015).”

Such treatment discontinuation itself may contribute to inferior outcomes in the placebo arms of trials, especially if treatment discontinuation is abrupt or rapid.

“Such treatment discontinuation itself may contribute to inferior outcomes in the placebo arms of trials, especially if treatment discontinuation is abrupt or rapid (Baldessarini et al., 2010, 2015; Baldessarini, 2013).”

These treatments involved the use of SNRIs, SSRIs, and other agents with demonstrated short-term efficacy in acute major depressive episodes.

“These treatments involved the use of SNRIs, SSRIs, and other agents with demonstrated short-term efficacy in acute major depressive episodes (Undurraga and Baldessarini, 2012; Baldessarini, 2013).”

Fair testing of protection against recurrences of major depression probably requires several years given the natural history of the illness, in which episodes typically reoccur less than yearly.

“That is, not all trials are likely to represent fair testing of protection against recurrences (not contaminated by relapses) of major depression, which probably requires several years given the natural history of the illness, in which episodes typically reoccur less than yearly (Baldessarini, 2013).”