Patient's Coping Skills and Environmental Stress Important to Understanding Recurrence During Antidepressant Maintenance

Letter to the Editor

Sir: Recently, Byrne and Rothschild reported on possible mechanisms for loss of antidepressant efficacy during maintenance therapy. Although I would agree with the theoretical mechanisms cited by the authors, there is a glaring oversight in their thinking about this important issue, specifically, the role of new psychosocial stresses encountered by the patient during the maintenance period, the cumulative effect of ongoing chronic psychosocial stress in the patient’s life, and ongoing coping deficits. Psychosocial stress that the patient cannot manage could overwhelm all or part of a previously positive biological antidepressant response.