Journal Mobile Options
Table of Contents
Vol. 72, No. 1, 2003
Issue release date: January–February 2003
Psychother Psychosom 2003;72:3–9

Management of Recurrent Depression in Primary Care

Fava G.A. · Ruini C. · Sonino N.
aAffective Disorders Program, Departments of Psychology, University of Bologna, Bologna, Italy; bDepartment of Psychiatry, State University of New York at Buffalo, Buffalo, N.Y., USA; cDepartment of Statistical Sciences and Department of Mental Health, University of Padova, Padova, Italy

Individual Users: Register with Karger Login Information

Please create your User ID & Password

Contact Information

I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in

First-Page Preview
Abstract of Case Management

Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.


  1. Judd LL: The clinical course of unipolar major depressive disorders. Arch Gen Psychiatry 1997;54:989–991.
  2. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Washington, American Psychiatric Association, 1994.
  3. Depression Guideline Panel: Depression in Primary Care. Detection and Diagnosis. Rockville, US Department of Health and Human Services, 1993, vol 1, p 21.
  4. Piccinelli M, Wilkinson G: Outcome of depression in psychiatric settings. Br J Psychiatry 1994;164:297–304.
  5. Lin EHB, Katon WJ, Von Korff M, Russo JE, Simon GE, Bush TM, Rutter CM, Walker EA, Ludman E: Relapse of depression in primary care. Rate and clinical predictors. Arch Fam Med 1998;7:443–449.
  6. Ramana R, Paykel ES, Cooper Z, Hayhurst H, Saxty M, Surtees PG: Remission and relapse in major depression: A two-year prospective follow-up study. Psychol Med 1995;25:1161–1176.
  7. Fava GA: Subclinical symptoms in mood disorders: Pathophysiological and therapeutic implications. Psychol Med 1999;29:47–61.
  8. Fava M, Kendler KS: Major depressive disorder. Neuron 2000;28:335–341.

    External Resources

  9. Ormel J, Oldehinkel T, Brilman E, Brink WV: Outcome of depression and anxiety in primary care. Arch Gen Psychiatry 1993;50:759–776.
  10. Frank E, Kupfer DJ, Perel JM, Cornes C, Jarrett DB, Mallinger AG, Thase ME, McEachran AB, Grochocinsky VJ: Three-year outcome for maintenance therapies in recurrent depression. Arch Gen Psychiatry 1990;47:1093–1099.
  11. Fava GA, Rafanelli C, Grandi S, Conti S, Belluardo P: Prevention of recurrent depression with cognitive behavioral therapy. Arch Gen Psychiatry 1998;55:816–820.
  12. Simon GE, Von Korff M, Rutter CM, Peterson DA: Treatment process and outcomes for managed care patients receiving new antidepressant prescriptions from psychiatrists and primary care physicians. Arch Gen Psychiatry 2001;58:395–401.
  13. Lin EHB, Simon GE, Katon WJ, Russo JE, Von Korff M, Bush TM, Ludman EJ, Walker EA: Can enhanced acute-phase treatment of depression improve long-term outcomes? Am J Psychiatry 1999;156:643–645.
  14. Thompson C, Kinmonth AL, Stevens L, Peveler RC, Stevens A, Ostler KJ, Pickering RM, Baker NG, Henson A, Preece J, Cooper D, Campbell MJ: Effects of a clinical-practice guideline and practice-based education on detection and outcome of depression in primary care. Lancet 2000;355:185–191.
  15. Katon W, Rutter C, Ludman EJ, Von Korff M, Lin E, Simon G, Bush T, Walker E, Unutzer J: A randomized trial of relapse prevention of depression in primary care. Arch Gen Psychiatry 2001;58:241–247.
  16. Mischoulon D, McColl-Vuolo R, Howarth S, Lagomasino IT, Alpert JE, Nierenberg AA, Fava M: Management of major depression in the primary care setting. Psychother Psychosom 2001;70:103–107.
  17. Fava GA: Long-term treatment with antidepressant drugs. Psychother Psychosom 2002;71:127–132.
  18. Kupfer DJ: Maintenance treatment in recurrent depression. Br J Psychiatry 1992;161:309–316.
  19. Edwards JG: Long-term pharmacotherapy of depression. BMJ 1998;316:1180–1181.
  20. Young AH: Recurrent unipolar depression requires prolonged treatment. Br J Psychiatry 2001;178:294–295.
  21. Baldessarini RJ: Drugs and the treatment of psychiatric disorders: Antidepressant and antianxiety agents; in Hardman JG, Limbird LE, Gilman AG (eds): Goodman and Gilman’s The Pharmacological Basis of Therapeutics, ed 10. New York, McGraw-Hill, 2001, pp 485–520.
  22. Kupfer DJ, Frank E, Perel JM, Cornes C, Mallinger AG, Thase ME, McEachran AB, Grochocinsky V: Five-year outcome for maintenance therapies in recurrent depression. Arch Gen Psychiatry 1992;49:769–773.
  23. Viguera AC, Baldessarini RJ, Friedberg J: Discontinuing antidepressant treatment in major depression. Harv Rev Psychiatry 1998;5:293–306.
  24. Dawson R, Lavori PW, Coryell WH, Endicott J, Keller MB: Maintenance strategies for unipolar depression. J Affect Disord 1998;49:31–44.
  25. Fava GA, Mangelli L, Ruini C: Assessment of psychological distress in the setting of medical disease. Psychother Psychosom 2001;70:171–175.
  26. Paykel ES, Tanner J: Life events, depressive relapse and maintenance treatment. Psychol Med 1976;6:481–485.
  27. Andrews G: Should depression be managed as a chronic disease? BMJ 2001;322:419–421.
  28. Fava GA, Ruini C, Mangelli L: Patients can be taught how to improve recovery (letter to the editor). BMJ 2001;322:1428.

    External Resources

  29. Baldessarini RJ, Ghaemi SN, Viguera AC: Tolerance in antidepressant treatment. Psychother Psychosom 2002;71:177–179.
  30. Byrne SE, Rotschild AJ: Loss of antidepressant efficacy during maintenance therapy. J Clin Psychiatry 1998;59:279–288.
  31. Schmidt ME, Fava M, Zhang S, Gonzales J, Raute NJ, Judge R: Treatment approaches to major depressive disorder relapse. 1. Dose increase. Psychother Psychosom 2002;71:190–194.
  32. Frank E, Kupfer DJ, Perel JM, Cornes C, Jarrett DB, Mallinger AG, Thase ME, McEachran AB, Grochocinsky VJ: Comparison of full-dose versus half-dose pharmacotherapy in the maintenance treatment of recurrent depression. J Affect Disord 1993;27:139–145.
  33. Davis JM, Janicak PG, Hogan DM: Mood stabilizers in the prevention of recurrent affective disorders: A meta-analysis. Acta Psychiatr Scand 1999;100:406–417.
  34. Maj M, Pirozzi R, Kemali D: Long-term outcome of lithium prophylaxis in patients initially classified as complete responders. Psychopharmacology 1989;98:535–538.
  35. Solomon DA, Keitner GI, Miller IW, Shea MT, Keller MB: Course of illness and maintenance treatments for patients with bipolar disorder. J Clin Psychiatry 1995;56:5–13.
  36. Fava GA, Molnar G, Grandi S, Sonino N: Prodromal symptoms and intermittent drug medication in mood disorders. Pharmacopsychiatry 1991;24:28–30.
  37. Kupfer DJ, Frank E, Perel JM: The advantage of early treatment intervention in recurrent depression. Arch Gen Psychiatry 1989;46:771–775.
  38. Streja DA, Hui Rl, Streja E, McCombs JS: Selective contracting and patients outcomes: A case study of formulary restrictions for selective serotonin reuptake inhibitor antidepressants. Am J Manag Care 1999;5:1133–1142.
  39. Croghan TW, Lair TJ, Engelhart L, Crown WE, Copley-Merriman C, Melfi CA, Obenchain RL, Buesching DP: Effect of antidepressant therapy on health care utilization and costs in primary care. Psychiatr Serv 1997;48:1420–1426.
  40. Simon GE, Von Korff M, Heiligenstein JH, Revicki DA, Grothams L, Katon W, Wagner EH: Initial antidepressant choice in primary care. JAMA 1996;275:1897–1902.
  41. Dunn RL, Donoghue JM, Ozminkowski RJ, Stephenson D, Hylan TR: Longitudinal patterns of antidepressant prescribing in primary care in the UK. J Psychopharmacol 1999;13:136–143.
  42. Fava GA, Rafanelli C, Grandi S, Canestrari R, Morphy MA: Six-year outcome for cognitive behavioral treatment of residual symptoms in major depression. Am J Psychiatry 1998;155:1443–1445.
  43. Fava M, Schmidt ME, Zhang S, Gonzales J, Raute NJ, Judge R: Treatment approaches to major depressive disorder relapse. 2. Reinitiation of antidepressant treatment. Psychother Psychosom 2002;71:155–199.
  44. Disalver SC: Heterocyclic antidepressant, monoamine oxidase inhibitor and neuroleptic withdrawal phenomena. Prog Neuropsychopharmacol Biol Psychiatry 1999;14:137–161.
  45. Zajecka J, Tracy KA, Mitchell S: Discontinuation symptoms after treatment with serotonin reuptake inhibitors. J Clin Psychiatry 1997;58:291–297.
  46. Fava GA, Ruini C: The sequential approach to relapse prevention in unipolar depression. World Psychiatry 2002;1:10–15.
  47. Blackburn IM, Moore RG: Controlled acute and follow-up trial of cognitive therapy in out-patients with recurrent depression. Br J Psychiatry 1997;171:328–334.
  48. Paykel ES, Scott J, Teasdale JD, Johnson AL, Garlan A, Moore R, Jenaway A, Cornwall PL, Hayhurst H, Abbot R, Pope M: Prevention of relapse in residual depression by cognitive therapy. Arch Gen Psychiatry 1999;56:829–835.
  49. Teasdale JD, Segal ZV, Williams JMG, Ridgeway VA, Soulsby JM, Lan MA: Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. J Consult Clin Psychol 2000;68:615–623.
  50. Jarrett RB, Kraft D, Doyle J, Foster BM, Eaves GG, Silver PC: Preventing recurrent depression using cognitive therapy with and without a continuation phase. Arch Gen Psychiatry 2001;58:381–388.
  51. Jarrett RB, Kraft D, Schaffer M, Witt-Browden A, Rissen R, Atkins DH, Doyle J: Reducing relapse in depressed out-patients with atypical features. Psychother Psychosom 2000;69:232–234.
  52. Fava GA, Bartolucci G, Rafanelli C, Mangelli L: Cognitive behavioral management of patients with bipolar disorders relapsing while on lithium prophylaxis. J Clin Psychiatry 2001;62:556–559.
  53. Fava GA, Ruini C, Rafanelli C, Grandi S: Cognitive behavioral approach to loss of clinical effect during long-term antidepressant treatment. Am J Psychiatry 2002;159:2094–2095.
  54. Fava GA, Fabbri S, Sonino N: Residual symptoms in depression: An emerging therapeutic target. Prog Neuropsychopharmacol Biol Psychiatry, 2002;26:763–770.
  55. Barbui C, Hotopf M: Amitriptyline versus the rest: Still the leading antidepressant after 40 years of randomised controlled trials. Br J Psychiatry 2001;178:129–144.
  56. Thase ME, Entsuah AR, Rudolph RL: Remission rates during treatment with venlafaxine or selective serotonin reuptake inhibitors. Br J Psychiatry 2001;178:234–241.
  57. Fava M, Davidson KG: Definition and epidemiology of treatment-resistant depression. Psychiatr Clin North Am 1996;19:179–200.
  58. Sonino N, Fava GA: CNS Drugs in Cushing’s disease. Pathophysiological and therapeutic implications for mood disorders. Prog Neuropsychopharmacol Biol Psychiatry 2002;26:1011–1018.
  59. American Psychiatric Association: Practice guideline for the treatment of patients with major depressive disorder (revision). Am J Psychiatry 2000;157(suppl):1–45.
  60. Schulberg HC, Katon W, Simon GE, Rush AJ: Treating major depression in primary care practice. Arch Gen Psychiatry 1998;55:1121–1127.
  61. Ellis PM, Smith DAR: Treating depression: The beyondblue guidelines for treating depression in primary care. ‘Not so much what you do but that you keep doing it’. Med J Aust 2002;176(10 suppl):S77–S83.
  62. Hollon SD, Shelton RC: Treatment guidelines for major depressive disorder. Behav Ther 2001;32:235–258.
  63. Fava GA: Conflict of interest and special interest groups. Psychother Psychosom 2001;70:1–5.
  64. Garfinkel PE: The changing culture related to the practice of psychiatry. Psychother Psychosom 2001;70:227–231.
  65. Starcevic V: Opportunistic ‘rediscovery’ of mental disorders by pharmaceutical industry. Psychother Psychosom 2002;71:305–310.
  66. Krimsky S: Journal policies on conflict of interest: If this is the therapy, what’s the disease? Psychother Psychosom 2001;70:115–117.
  67. Murray CJ, Lopez AD: Alternative projections of mortality and disability by cause 1999–2020: Global burden of disease study. Lancet 1997;349:1498–1504.
  68. Tuomilehto J, Lindstrom J, Eriksson JG, Valle TT, Hamalainen H, Ilanne-Parikka P, Keinannen-Kiukanniemi S, Laakso M, Louhoranta A, Rastas M, Salminen V, Uusitupa M: Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001;344:1343–1356.
  69. Ryff CD, Singer B: Psychological well-being. Psychother Psychosom 1996;65:14–23.
  70. Otto MW, Nierenberg AA: Assay sensitivity, failed trials, and the conduct of science. Psychother Psychosom 2002;71:241–243.

Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50