Three-year outcome of family intervention versus dose increase in loss of efficacy during long-term antidepressant drug treatment.

The return of depressive symptoms during long-term maintenance treatment is a common phenomenon, but has attracted very limited research attention. Twenty outpatients with recurrent major depressive disorder who had at least 3 episodes with the immediately preceding one no more than 2.5 years before the onset of the episode which led to antidepressant treatment, who lived with a partner and relapsed while taking antidepressant drugs were randomly assigned to: (a) family intervention approach according to the McMaster model and maintenance of the antidepressant drug at the same dosage; (b) dose increase and clinical management. A 3-year follow-up was performed. Seven of 10 patients responded to an increased dosage but all relapsed again at follow-up (6 within one year). Seven of the 10 patients responded to family intervention, but only 2 relapsed during the 3-year follow-up. The findings of this preliminary extended outcome study suggest that application of a family intervention approach is feasible when there is a loss of clinical effect during long-term antidepressant treatment and this approach may carry long-term benefits.