Relapse of Depressive Symptoms After Discontinuing Sertraline

To the Editor: Dr Keller and colleagues¹ report marked differences between continuing and discontinuing previously successful treatment with sertraline hydrochloride in patients with chronic depression. New episodes occurred in 10% of patients continuing sertraline (146 mg/d) for up to 18 months vs 30% after discontinuing sertraline and changing to placebo (over a period of 2.9 weeks), with new symptoms developing in 45% vs 72%, respectively. These differences (20%-27%) indicate a moderate sparing of relapse. It is remarkable that so many formerly long-term ill patients did so well after switching to placebo, but some may represent previously undertreated but reversible disorders.