Long-term management of depression: tips for adjusting the treatment plan as the patient's needs change.

Depression is a difficult-to-treat condition. Most individuals with depression do not achieve remission with any single treatment, and, when they do achieve remission, the majority will have residual symptoms. Therefore, clinicians must be prepared to aggressively manage relapse and recurrence throughout all phases of treatment. The ultimate goals for the long-term treatment of depression are to (1) help the patient achieve remission, (2) keep the patient as asymptomatic as possible, and (3) manage risk factors for subsequent episodes. Psychotherapies and pharmacotherapies appear to have dissimilar mechanisms of action and produce different effects in depression; psychotherapy, particularly cognitive-behavioral therapy and behavioral activation therapy, may have more of a relapse prevention effect than pharmacotherapy. Because chronicity and recurrence are the rule rather than the exception, clinicians should choose treatments that have shown efficacy for protecting against future episodes. In addition, factors such as comorbidities and stressful life events increase the likelihood of depressive relapse; thus, these problems must be addressed to prevent a full relapse. By anticipating and adjusting treatment to meet patients' changing needs over time, clinicians can help them achieve and maintain remission from depression. Copyright 2009 Physicians Postgraduate Press, Inc.