If you have a chance..04 Mar 2016
Screen Time at Bed Time11 Apr 2016
I am commonly asked about length of treatment from my patients. Please note the comments in this article – should not be taken as medical advice and all decisions about medication should be discussed with your treating doctor.
Please ensure that you understand – What is major depressive disorder (MDD)? – before reading this article.
To answer this question patients need to understand the different phases of treatment for depression.
There are three main phases in the treatment of major depression.
1) Acute phase – where remission occurs of symptoms (minimum 6 – 8 weeks)
2) Continuation phase (full remission is preserved, and relapse is prevented – normally about 4-5 months after acute phase)
3) The maintenance phase of treatment ( this is where susceptible patients are protected against recurrence or relapse of subsequent major depressive episodes (duration varies with frequency and severity of previous episodes) ).
Every patient moves through each of these phases.
How long an individual is on medication depends on
o Whether this was the first episode of depression?
o If this is a recurring depression
o The severity of depressive episodes ( i.e., are they associated with suicidal thoughts, admission to hospital). If they are very severe, stopping treatment needs to be carefully considered.
o Previous response to medication
o Response to the medication
The aim in antidepressant treatment is to treat the depression to a level that the symptoms of depression are no longer present (I.e., full remission). Some individuals on antidepressants respond to antidepressants but not completely – they still have some lingering effects of depression, notably fatigue or concentration and memory problems.
Please discuss this with your doctor – and determine if these symptoms are potentially a partial response to medication. If that is the case – changes may need to be made to get to complete remission of symptoms.
The reason for aiming for ‘full remission’, is because when patients stop antidepressants and haven’t completely experienced full remission from their depressive symptoms they are more likely to have a relapse of depression once stopping medications.
For first episodes of MDD – you can expect to stay on medications for at least 6 – 9 months, assuming that you have fully recovered from the illness.
For patients with recurrent depression – i.e., 2/3 or more episodes depending on where you read, they can expect to stay on medication for a longer time.
Research has shown us that these patients can expect to stay on medication for at least 5 years. Individuals who have two or more lifetime episodes of depression, ongoing social stressors , severe depressive episodes or any other additional disorders ( ie anxiety or substance dependence) should consider being on maintenance therapy ie long term. Maintenance therapy can be discussed with your doctor – it depends on patient preference, response to medication and side effects of medication.
This is a useful article I recently found on this topic from the Wall Street Journal. Im interested to hear your comments on it. The Mystery of When to Stop Antidepressants.
This article is primarily about medications. Psychiatry is not an exact science however, and not everyone responds the same way to medication. Other routes of treatment include interpersonal psychotherapy, cognitive behavioural therapy and mindfulness therapy and they have shown similar treatment effects in recurrent depression. Please discuss this with your doctor.