If you have had an episode of depression, gotten treatment for it, and are now feeling better, this is great news. But you may have questions about how long your treatment should continue.
Although some people go through life only having one episode of depression, many people have a long-term problem with their mood. That’s why your doctor may ask you to continue your treatment even if you feel better.
“Maintenance treatment” refers to the care you get after you have been feeling well for about six months. Both medication and psychotherapy may both play a role in your ongoing treatment.
Treating depression often involves numerous health professionals. It’s a good idea to choose one person who can lead your treatment team. This is the person you consult with about your overall plan. Be sure you understand the pros and cons of continuing treatment. Also understand all of your options.
Many people choose to continue treatment indefinitely, because they feel well and the side effects are tolerable or non-existent. The follow up need not be burdensome. It may be as simple as an annual “check-up.”
Ongoing Drug Treatment
Here are two questions that can help you frame your choice about medication:
How unpleasant are drugs side effects compared to the benefit I get?
What is the risk that my depression will return if I stop taking the drug?
Weighing your options. If your drug treatment has relieved your depression, and side effects have been insignificant or tolerable, your doctor may suggest that you stay on your medication for at least six to nine months. At the end of this time, you may choose to go on taking it (because it was helpful and you had no or few side effects). Or you may prefer to stop the drug. If you stop, there is a chance that your depression will return. Discuss the specific risks of relapse with your doctor.
Note: Stopping any antidepressant suddenly may lead to uncomfortable symptoms. These symptoms are rarely, if ever, dangerous, but you can avoid them by working with your doctor to taper your dose. Restarting the drug (or a similar drug) can reverse these symptoms if they occur.
The risk of depression coming back. As the risk of recurrence increases, more people decide to continue drug treatment.
Depression is likely to recur if:
- You have had more than one episode of depression in the past.
- You experience a lot of stress.
- You have lingering symptoms of depression, even though your depression has been treated.
- You have other mental-health problems.
- You have had a previous episode of severe depression, with suicidal thoughts, psychosis or very poor functioning.
- Other members of your family have been diagnosed with depression.
- You drink alcohol or use illegal drugs excessively.
If you decide to continue your medication, most experts recommend that you continue at the dose that worked for you at the start. Some people try taking a lower dose during their maintenance treatment, but reducing the dose may increase your chance of a relapse. Only consider using a lower dose if you have troubling side effects, but be aware that a lower dose may not control your symptoms as effectively. If your symptoms come back, you can increase your dose again. Or, you can try another antidepressant, one that may provide equal benefit but with fewer side effects.
An important matter — put yourself first. When it comes to drug treatment, make the decision that is best for you. Some people — especially people who have never experienced depression — have strong biases against medication. While you shouldn’t underestimate a drug’s potential side effects, it is equally important that you not underestimate the problems and dangers associated with depression, especially if you fall into one of the higher risk groups. For those people most affected by depression, maintenance treatment is a great idea.
If you have been participating in psychotherapy, ask yourself the following questions:
- Am I feeling better?
- Do I understand my problems or myself better?
- Have I made the changes I wanted to make?
- Do I feel I can maintain these changes?
- Have I met my goals?
- Have I discovered other goals that I want to continue to pursue?
- Is psychotherapy helping me reach my goals?
- Would other treatment options (for example, another style of therapy, a different therapist, a medication) help me more?
How often you meet with your therapist and how long (in weeks, months or years) you continue therapy depends on your goals and on the type of therapy. There is no single “right” length of time for therapy. And it is not a race, either. You may learn in just a few sessions all you need to know to make necessary changes or you may find that an extended period of therapy is very valuable.
In some situations, the ongoing support of a therapist is key to maintaining your progress or self-esteem. Continuing therapy may lead to further growth, enabling you to respond more effectively to life’s challenges. Even after therapy ends, it may be useful to visit your therapist periodically. Follow-up visits may be valuable if you slip back into old patterns.
Deciding when to stop therapy is complicated. There are often advantages to staying longer. And it may be difficult to give up a strong relationship with your therapist. Remember that your therapist is a consultant who provides a service to you. You are free to decide whether or not the psychotherapy is helping you to keep your depression at bay.