There is increasing realization that unipolar major depressive disorder (MDD) is primarily a chronic disease with frequent episode relapses and recurrences across the life cycle and not merely an isolated single acute episode illness. This recent paradigm shift in the concept of unipolar MDD1 has made delay or prevention of episode relapse a fundamental treatment goal in the clinical management of unipolar MDD. It is surprising, that apart from the earlier series of investigations by the Pittsburgh group,2,3 that there is a scarcity of controlled studies, in which delay or prevention of episode relapse is the main focus of the study. Thus, we read with interest the study of Fava et al.4 This is an important study for which we wish to commend the authors. However, we would like to raise an issue that may be important for the interpretation of their data.
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