治疗的目标是症状完全缓解,恢复到正常的社会功能。对于第一次抑郁发作的患者而言,达到缓解需要数月,并在缓解后仍需要持续至少9到12个月的治疗。[97]Geddes JR, Carney SM, Davies C, et al. Relapse prevention with antidepressant drug treatment in depressive disorders: a systematic review. Lancet. 2003 Feb 22;361(9358):653-61.http://www.ncbi.nlm.nih.gov/pubmed/12606176?tool=bestpractice.com[98]El-Mallakh RS, Briscoe B. Studies of long-term use of antidepressants: how should the data from them be interpreted? CNS Drugs. 2012 Feb 1;26(2):97-109.http://www.ncbi.nlm.nih.gov/pubmed/22296314?tool=bestpractice.com复发:高质量证据显示,使用处方抗抑郁药维持治疗较安慰剂更能降低在 1 到 3 年内患者的复发率。系统评价或者受试者>200名的随机对照临床试验(RCT)。 对于多次发作的患者,或者存在复发的高危因素的患者,证据支持更长的时间服用抗抑郁药治疗。[98]El-Mallakh RS, Briscoe B. Studies of long-term use of antidepressants: how should the data from them be interpreted? CNS Drugs. 2012 Feb 1;26(2):97-109.http://www.ncbi.nlm.nih.gov/pubmed/22296314?tool=bestpractice.com
在停止治疗 1 年内,大约三分之一的患者会复发,而终生复发率超过 50%。[11]Remick RA. Diagnosis and management of depression in primary care: a clinical update and review. CMAJ. 2002 Nov 26;167(11):1253-60.http://www.ncbi.nlm.nih.gov/pubmed/12451082?tool=bestpractice.com 尚不明确关于抗抑郁药能预防复发的证据。[98]El-Mallakh RS, Briscoe B. Studies of long-term use of antidepressants: how should the data from them be interpreted? CNS Drugs. 2012 Feb 1;26(2):97-109.http://www.ncbi.nlm.nih.gov/pubmed/22296314?tool=bestpractice.com[109]Cuijpers P, Geraedts AS, van Oppen P, et al. Interpersonal psychotherapy for depression: a meta-analysis. Am J Psychiatry. 2011 Jun;168(6):581-92.http://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2010.10101411http://www.ncbi.nlm.nih.gov/pubmed/21362740?tool=bestpractice.com 15 年后,87% 的患者曾有过复发。对于有 3 次复发发作的患者,许多专家提倡长期维持治疗。