Question: Do depressive episodes become more difficult to treat and more recurrent over time?
The patient in question has a 13 year old history of recurrent unipolar major depressive episodes. The initial 4 episodes were readily treated to the full remission and he discontinued treatment each time several months to a year after remitting. Eventually, his subsequent episodes came in an ever escalating pattern with less and less time between them. The patient became resistant by the time of his 5th episode and he took 2 years to get better.
From the above case, it is evident that the major depression can be recurrent that can be characterized by shorter and shorter periods of wellness between subsequent episodes that ultimately results into treatment resistance. The resistance may result from neurotrophic factors and the changes in the brain structure. Those with 3 or more episodes of depression should be treated indefinitely with antidepressant maintenance. Despite the risks associated with them, the antidepressant-induced sexual dysfunction provides a powerful reason to discontinue antidepressants.
In order to prevent future cases of resistance, the patient should have been treated with maintenance antidepressants after the third episode of depression to prevent the future episodes and resistance. Furthermore, more efforts ought to have been made to get the patient into psychotherapy to help solve the mortality issues. The patients with recurrent episodes for depression needs maintenance treatment and a thorough follow up to ensure that they respond positively to treatment (Stahl, 2014).
MAO inhibitors have remained powerful alternatives for the treatment of depression in cases of recurrent episodes. Despite the various myths concerning these drugs, they have provided some relief to patients with recurrent depression. Further studies need to be carried out to dispel the facts surrounding these myths.
It is evident that the depressive episodes become more difficult to treat and more recurrent over time. The antidepressant maintenance needs to become indefinite whenever there is a particular severe episode of one with suicidal cases probably needing maintenance (Stahl, 2013). Also, the antidepressant maintenance needs to become indefinite following the remission from three episodes of major depression. However, the antidepressant maintenance should not become indefinite following one episode of major depression. It is not necessary at one episode of depression unless particularly severe and other risk factors such as suicidality and highly positive family history is realized. On the same note, the antidepressant maintenance should not become indefinite following remission of two episodes of major depression. The second episode is mostly associated with non complicated cases that do not require indefinite maintenance. Finally, the antidepressant maintenance should not become indefinite on case by case analysis. The treatment regime should be more systematic as opposed to case by case analysis.
Stahl, S. M. (2014). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.