Treatment of Recurrent Unipolar Major Depressive Disorder

The publication in this issue of theArchivesof the report from the Pittsburgh (Pa) studies¹on long-term treatment of recurrent unipolar major depression is important for a number of reasons.²⁻⁴ The major findings are as follows: (1) high rate of recurrence in 1 year for untreated control groups; (2) clinically meaningful and statistically significant prevention of relapse See also p 1093.and recurrence using both imipramine hydrochloride and interpersonal psychotherapy (IPT); (3) trend toward value of combined treatment; and (4) the value of high-dose imipramine hydrochloride (over 200 mg/d) and blood level determinations to enhance pharmacotherapy (Fig1). These findings have an immediate practical application to the clinical management and treatment of this important group of patients. While there may be controversy regarding the natural history of major depression, particularly the kraepelinian concept of high rates of remission of the acute episode and favorable outcome over