Citation

Fritze J. Psychopharmakotherapie 1997; 4(Suppl 6): 17-25.

Copyright

(Copyright © 1997, Wissenschaftliche-Verlagsgesellschaft)

DOI

unavailable

PMID

unavailable

Abstract

Unipolar depression is a wide-spread disease. The cumulative lifetime risk amounts to 4.4% in men and to 13.5% in women in Germany. If untreated the episode lasts five to nine months. Depression becomes chronic in at least 10% of patients, it takes a recurrent course in 40-80 %. Each episode bears the risk of suicide. Therefore, antidepressant maintenance therapy is recommended for at least additional six months after clinical remission. The life long prophylactic antidepressant treatment for the prevention of recurrences is presently recommended if the age at first onset is over 50 years or after two episodes and an age at onset above 40 years or after the third episode. Other predictors of recurrence such as positive family history, a family atmosphere of high expressed-emotion (HEE), or an unstable premorbid personality have not been considered quantitatively in decision algorithms up to now. For recurrence prevention, antidepressants, lithium and carbamazepine seem to be equally effective. Lithium, however, is the only compound for which the prevention of suicide is established. Carbamazepine might be a worse alternative in that it seems not to prevent suicide as effectively, moreover, carbcunazepine induces liver enzymes resulting in pharmacokinetic interactions with antidepressants. The question of recurrence preventive therapy starting with the very first episode is open to debate, arguments in favor are discussed. Recurrence prevention offers a specific chance to prevent suicide.

Language: de