Il trattamento a lungo termine della Depressione Unipolare: focus sulla terapia con Venlafaxina RP

Depression is the most common of all the major mental illnesses with one year prevalence in European countries of around 5%, and with a range from 3.1% to 10.1%. Depressive Episodes are associated with disability and frequently have a long duration: in one third of patients the episode will last for more than 2 years, the criteria for chronic depression. Recurrence is predicted by a number of factors including severity of depression, number of prior episodes, time since previous episode and absence of remission or presence of subsyndromal symptoms. The likelihood of recurrence increases with the number of previous episodes and the severity of the current episode: once a patient has suffered from three episodes of depression, he has more than 95% chance of having another. Although effective pharmacotherapeutic agents are available, depressed patients are often undertreated or treated for an inadequate period of time. Initial acute treatment of Major Depression results in a significant lessening of depressive symptoms (response) progressing to absence of depressive symptoms (remission) which means the return to the patient’s premorbid state. Stable remission for 46 months is thought of as a recovery. A worsening of symptoms or the return of a major depression is considered a relapse before recovery has been achieved and recurrence if it occurs later. The distinction between remission vs. recovery and relapse vs. recurrence is not possible. The three phases of treatment are: acute therapy; continuation therapy; maintenance therapy. The acute phase of therapy covers the time period from the beginning of treatment to remission, which is the primary therapeutic goal. The continuation phase follows the acute phase to preserve and stabilize the remission. It is the phase in which the treatment is extended for a period of time in order to prevent a return of depression. Long-term maintenance treatment is aimed at the prevention of a new episode of depression. Long-term tolerability is, therefore, important in facilitating adherence to treatment and thereby control over depressive symptoms. The new Selective Serotonin Reuptake Inihibitors (SSRIs) and Serotonin Noradrenaline Reuptake Inihibitors (SNRIs) are generally better tolerated than older treatments, such as Tricyclic antidepressants and Monoamine Oxidase Inhibitors. Venlafaxine XR, with its dual action of serotonin and noradrenergic reuptake inhibition, has been shown to be superior in efficacy to Selective Serotonin Reuptake Inhibitors for severe Majors Depressive Disorder. Clinical studies suggests that it has a rapid onset of action, producing significant clinical improvement in the first or second week of treatment, and long-term efficacy and may have consistently superior remission rates compared with the SSRIs. Moreover Venlafaxine XR (extended release) was effective in 92% of depressed patients in preventing recurrence in the second year of maintenance therapy (Prevent Study).