***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: During the past 25 years , 24 r and omized trials of intravenous ( IV ) fibrinolytic treatment have been reported , involving a total of some 6000 patients in the acute phase of myocardial infa rct ion . Most tested IV streptokinase ( SK ) , but a few tested IV urokinase ( UK ) . In the past 2 or 3 years numerous small r and omized trials of intracoronary ( IC ) SK have been started , 9 of which , involving a total of about 1000 such patients , have been reported . Because all of these IV and IC trials were small ( the largest including only 747 patients ) , their separate results appear contradictory and unreliable . But , an overview of the data from these trials indicates that IV treatment produces a highly significant ( 22 % + /- 5 % , P less than 0.001 ) reduction in the odds of death , an even larger reduction in the odds of reinfa rct ion , and an absolute frequency of serious adverse effects to set against this that is much smaller than the absolute mortality reduction . The apparent size of the mortality reduction in the IV trials was similar whether anticoagulants were compulsory or optional , whether treatment was in a coronary care unit or an ordinary ward and , surprisingly , whether treatment began early ( less than 6 h from onset of symptoms ) or late ( generally 12 - 24 h ) . In addition , there was no evidence that UK was more effective than the less expensive SK , or that , despite their technical complexity , the new IC regimes were more effective than the old IV regimes . Even the IV schedules that have been studied in r and omized trials were , however , quite complex , and the IC schedules were far more so . Perhaps partly because of this , none of them is widely used . If so , then some much simpler , and hence more widely practicable , IV SK regimes should be developed and tested . For example , a simple one hour high-dose IV SK infusion , without anticoagulation , will successfully convert virtually all of the available plasminogen into plasmin . But , it may be several years before the net effects on mortality of any more widely practicable IV SK regimes can be agreed unless many of the hospitals that do not wish routinely to use IC regimes or the complex previous IV regimes will collaborate in multicentre r and omized trials that can , if necessary , continue rapid intake until some tens of thous and s of patients have been r and omized , and some thous and s of deaths have been observed among the control and treated patients . The same , of course , may be true for any other fibrinolytic regimes ( e.g. infusion of tissue plasminogen activator ) if their net effects on mortality are comparable to those of IV SK Prevention of relapse following depression is a pressing research problem . The authors tested the efficacy of the tricyclic antidepressant amitriptyline and psychotherapy , alone and in combination , in preventing the relapse of 150 neurotic depressed female patients . They found that patients receiving amitriptyline and little psychotherapy had a 12-percent relapse rate , compared to a 16-percent rate for those receiving more psychotherapy and no medication . There was no significant difference between drug therapy alone or drug therapy in combination with psychotherapy . However ,  psychotherapy was beneficial to patients with problems of social adjustment and interpersonal relations .  The need for further research and implication s for treatment are discussed BACKGROUND The highly recurrent nature of major depression in the young and the elderly warrants long-term antidepressant treatment . AIMS To compare the prophylactic efficacy of citalopram and placebo in elderly patients ; to evaluate long-term tolerability of citalopram . METHOD Out- patients , > or = 65 years , with unipolar major depression ( DSM-IV : 296.2 x or 296.3 x ) and Montgomery-Asberg Depression Rating Scale score > or = 22 were treated with citalopram 20 - 40 mg for 8 weeks . Responders continued on their final fixed dose of citalopram for 16 weeks before r and omisation to double-blind treatment with citalopram or placebo for at least 48 weeks . RESULTS Nineteen of the 60 patients using citalopram  v. 41 of the 61 patients using placebo  had recurrence . Time to recurrence was significantly different between citalopram- and placebo- patients , in favour of citalopram ( log-rank test , P<0.0001 ) . Long-term treatment was well tolerated . CONCLUSIONS Long-term treatment with citalopram is effective in preventing recurrence of depression in the elderly and is well tolerated BACKGROUND Major depression is highly recurrent . Antidepressant maintenance treatment has proven efficacy against recurrent depression . AIMS Comparison of prophylactic efficacy of citalopram versus placebo in unipolar , recurrent depression . METHODS Patients 18 - 65 years of age with recurrent unipolar major depression ( DSM-IV ) , a Montgomery-Asberg Depression Rating Scale score of > or = 22 and two or more previous depressive episodes , one within the past 5 years , were treated openly with citalopram ( 20 - 60 mg ) for 6 - 9 weeks and , if responding , continued for 16 weeks before being r and omised to double-blind maintenance treatment with citalopram or placebo for 48 - 77 weeks . RESULTS A total of 427 patients entered acute treatment and 269 were r and omised to double-blind treatment .  Time to recurrence was longer in patients taking citalopram than in patients taking placebo ( P:<0.001 ) . Prophylactic treatment was well tolerated . CONCLUSIONS Citalopram ( 20 , 40 and 60 mg ) is effective in the prevention of depressive recurrences .  Patients at risk should continue maintenance treatment at the dose necessary to resolve symptoms in the acute treatment phase BACKGROUND Depression is now seen as a chronic disabling condition that spans the patient 's lifetime and creates significant medical , economic and quality of life consequences . METHODS 500 depressed patients were treated with milnacipran for 6 months . A total of 214 recovered patients were r and omised to receive either milnacipran ( 50 mg bid ) or a matching placebo for a 1-year recurrence prevention phase . Recurrence rate was the primary criteria ; quality of life ( QoL ) consequences were evaluated through a shortened version of the French Sickness Impact Profile ( SIP ) , the Depression Impact Profile ( DIP ) . RESULTS Milnacipran demonstrated its ability to reduce recurrences ( Odds-Ratio=1.5 ; P<0.05 ) , with a more marked effect in recovered patients with few residual symptoms ( Odds-Ratio=3.0 ) . Responders who continued treatment with milnacipran had a dramatic improvement in their quality of life , although patients with residual symptoms still experienced some deterioration in their QoL ( recreation , emotional , social , alertness and home assistance scores ) . Even recovered patients having zero scores on the Hamilton Depression Rating Scale-21 items ( HDRS ) had some QoL deterioration . The DIP emotional score was found to be more predictive of recurrence than the HDRS . Overall , the QoL was improved for those in the milnacipran group in comparison to placebo on the mobility , communication , psycho-social and total scores . LIMITATIONS The QoL evaluation was a secondary criteria ; no a priori sample size estimate was performed . The choice of a generic QoL instrument might have reduced the sensitivity to clinical changes in depression . CONCLUSIONS Prevention of recurrence in MDD with milnacipran contributes to an improvement in the Nine of 15 elderly male VA out patients receiving long-term tricyclic antidepressant therapy  underwent gradual placebo substitution under double-blind conditions . Three of the 9 ( 33.3 % ) experienced a reoccurrence of depressive symptoms on placebo ( at 4 , 5 and 6 months ) . None of the 6 remaining on active medication experienced a reoccurrence . The Hamilton Depression Scale and Montgomery Asberg Depression Rating Scale scores indicate a significantly ( P less than 0.05 ) worse outcome for those switched to placebo . The results suggest the need for close follow-up after discontinuation of antidepressant therapy in this population Several controlled studies have demonstrated the efficacy of continuation therapy with tricyclic antidepressants , but little is known about continuation therapy with the monoamine oxidase inhibitors . Moreover , the usefulness of continuation antidepressant therapy in patients with chronic depressive disorders has not been evaluated . This pilot study reports initial results of a double-blind continuation trial of phenelzine or placebo following an initial antidepressant response to phenelzine in 12 patients who met DSM-III criteria for dysthymic disorder . All 7 patients r and omized to placebo  relapsed , whereas only 1 of the 5 patients who continued to receive phenelzine relapsed . These results suggest that continuation therapy with phenelzine may be useful in maintaining clinical response after acute treatment BACKGROUND The long-term efficacy and tolerability of the antidepressant reboxetine , a unique selective norepinephrine reuptake inhibitor ( selective NRI ) , were assessed in an international study . METHOD Two hundred eighty-three patients with recurrent DSM-III-R major depression who responded to 6 weeks of reboxetine treatment ( > or = 50 % decrease in Hamilton Rating Scale for Depression [ HAM-D ] total score ) were r and omly assigned to receive reboxetine or placebo for 46 weeks in a double-blind phase . Relapse ( > or = 50 % increase in HAM-D total score and /or a HAM-D total score > or = 18 ) rate was the principal assessment criterion and included patients who experienced relapse or recurrence . Only patients who remained relapse-free at the end of the first 6-month treatment period were included in the relapse rate assessment at the end of the second 6-month treatment period . RESULTS Reboxetine was associated with a markedly lower relapse rate than placebo ( 22 % vs. 56 % ; p<.001 ) and a greater cumulative probability of a maintained response ( p = .0001 ) during long-term treatment . Patients in remission ( HAM-D total score < or = 10 ) at the time of r and om assignment were less likely to relapse ( 16 % reboxetine , 48 % placebo ; p<.001 ) . The proportion of patients who were relapse-free and therefore remained in the study was significantly ( p < or = .001 ) higher among those on reboxetine treatment than on placebo at the end of the first ( 61 % vs. 40 % ) and second ( 88 % vs. 59 % ) 6 months of treatment . Additional efficacy measures supported these findings . The incidence of adverse events with reboxetine was low and comparable with that for placebo .  Discontinuation due to adverse events occurred infrequently . CONCLUSION Reboxetine treatment over 1 year is more effective than placebo in the prevention of relapse in patients with recurrent depression . The low relapse rates at the end of the second 6 months of treatment further suggest that reboxetine effectively prevents recurrence of depressive symptoms following episode resolution . Reboxetine is well tolerated in long-term treatment of depression , a finding that bodes well for long-term patient compliance Abstract A double-blind clinical trial has been carried out to ascertain whether patients who have made a good recovery from depressive illness with tricyclic-antidepressant medication  derive any benefit from continuation of therapy with the same drug at a lower dose level . Of the 92 patients who entered the trial , significantly fewer on active treatment relapsed during the six-month trial period— 22 % , compared with 50 % of patients receiving placebo .  Patients with residual symptoms on entry to the trial derived more benefit from continuation therapy than patients who had recovered completely In a double-blind , long-term follow-up study , 117 bipolar patients received lithium carbonate , imipramine hydrochloride , or both and 150 unipolar patients received lithium carbonate , imipramine , both lithium carbonate and imipramine , or placebo . With bipolar patients , lithium carbonate and the combination treatment were superior to imipramine in preventing manic recurrences and were as effective as imipramine in preventing manic recurrences and were as effective as imipramine in preventing depressive episodes . The combination treatment provided no advantage over lithium carbonate alone . With unipolar patients , imipramine and the combination treatment were more effective than lithium carbonate and placebo in preventing depressive recurrences . The combination treatment provided no advantage over imipramine alone . The lithium carbonate-treated group had fewer manic episodes than the other groups . Treatment outcome , which was evaluated primarily in terms of the occurrence of major depression or manic episodes , was significantly related to characteristics of the index episode , ie , the episode that brought the patient into the study CONTEXT Elderly patients with major depression are at high risk for recurrence , increased mortality , and chronic disability . OBJECTIVE To determine the efficacy of maintenance nortriptyline hydrochloride and interpersonal psychotherapy ( IPT ) in preventing recurrence of major depressive episodes in patients older than 59 years . DESIGN A 2 x 2 r and omized , double-blind , placebo-controlled clinical trial , stratified by therapist . SETTING University-based psychiatric research clinic . PATIENTS Of a total of 187 patients with recurrent nonpsychotic unipolar major depression ( average age , 67 years ; one third aged > or = 70 years ) recruited through clinical referral and media announcements , 107 were fully recovered after open acute and treatment continuation with n 
    Output:
    
INTERPRETATION Antidepressants reduce the risk of relapse in depressive disorder , and continued treatment with antidepressants would benefit many patients with recurrent depressive disorder .
The treatment benefit for an individual patient will depend on their absolute risk of relapse with greater absolute benefits in those at higher risk .