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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.

The reported pattern of relapses is well-known in discontinuation trials, with a sharp, early separation of treated and discontinued patients, and little difference after the first few months.^2-4 Computed rates (95% confidence interval [CI]) of return of depressive symptoms in weeks 1 to 24 were 1.91 (95% CI, 1.58-2.24) per . . . [Full Text of this Article]