Discontinuation
Stable patients may discontinue treatment after the continuation phase if maintenance treatment is not required. All classes of antidepressants should be tapered over several weeks to minimize recurring symptoms or medication discontinuation syndromes. Patients should be informed of the risk of relapse, and early signs of depression should be reviewed along with a plan for seeking treatment. A follow-up visit should be scheduled within the first 2 months after discontinuation of treatment, because this is the period of highest relapse risk.
The Bottom Line
Establishing a therapeutic alliance and planning the treatment course will assist in achieving the best outcome. The acute phase of treatment should include an SSRI, SNRI, bupropion, or mirtazapine for most patients. At least 4-6 weeks should be allowed for significant improvement; some improvement should be seen in the first few weeks. All patients need continuation therapy, with some requiring lifelong maintenance therapy. Close monitoring is of utmost importance throughout treatment.
Reference:
• Practice Guideline for the Treatment of Patients With Major Depressive Disorder, Third Edition.
Dr. Olson is a second-year resident in the family medicine residency program at Abington (Pa.) Memorial Hospital. Dr. Skolnik is an associate director of the family medicine residency program at Abington Memorial Hospital.