Staying Well Once Your Depression Is Treated
April 08, 2003
Although some people have only one episode of depression, many people have ongoing problems. Depression treatment does not stop once you start feeling better.
Maintenance treatment is usually advised if you are at high risk of recurrent depression. Maintenance treatment begins once you have been feeling good for about six months. The most common advice about maintenance treatment is to continue doing what keeps you feeling well. This is probably an extension of whatever treatment helped you in the first place. Drug treatment and psychotherapy may both play a role.
Because the treatment of depression often involves a few different providers (such as your primary-care physician, a psychiatrist, and/or a psychotherapist or counselor), you may want to use one of these providers as a consultant in your ongoing treatment. In the best circumstance, this person is available to discuss the pros and cons of different forms of maintenance treatment and can help you decide whether to keep using drug treatment or how long to continue psychotherapy.
Depression is often a life-long matter. It is beneficial to develop a long-term relationship with a provider whom you trust.
Ongoing Drug Treatment
Ask yourself the following two questions:
o If you continue using drug treatment, how unpleasant are the side effects?
o If you stop using drug treatment, what is the risk that your depression will return?
Weighing your options. If you have had a good result from drug treatment, with few side effects, your health-care provider will probably suggest continuing drug treatment for at least six to nine months. At the end of this period, you may choose to continue drug treatment (because it was helpful and easy to take) or you may prefer to see what happens if you stop drug treatment. If you stop, there is a chance your depression will return. You should discuss the risks with your health-care provider.
Be aware that stopping any antidepressant abruptly may lead to uncomfortable symptoms. These symptoms are rarely, if ever, dangerous, but you can avoid them by working with your health-care provider to taper your dose. Restarting the drug (or a similar drug) can also reverse these symptoms.
The risk of recurrence. As the risk of recurrence increases, more people decide to continue drug treatment. Depression is likely to recur when:
o You have had more than one episode of depression in the past.
o You experience a lot of stress.
o You have lingering symptoms of depression, even though your depression has been treated.
o You have other mental-health problems.
o You have had a previous episode of severe depression, with suicidal thoughts, psychosis, or very poor functioning.
o Other members of your family have been diagnosed with depression.
o You drink alcohol excessively or use drugs.
If you decide to continue drug treatment, you should probably continue to take the same doses that worked for you at the start. Although it is a common practice to take a lower dose during maintenance treatment, reducing the dose may increase your chance of relapse. Only consider using a lower dose if you have troubling side effects; be aware that a lower dose may be less effective at controlling your symptoms. If your symptoms come back, you can increase your dose again. Or you can try another antidepressant to see if there is equal benefit with fewer side effects.
A final thought. When it comes to drug treatment, make the decision that is best for you. Do not underestimate the problems and dangers associated with depression, especially if you have had multiple episodes or if you have lingering symptoms. For those most affected by depression, maintenance treatment is highly desirable.
If you have been using psychotherapy to treat your depression, ask yourself the following questions:
o Are you feeling better?
o Do you understand your problems or yourself better?
o Have you made the changes you wanted to make?
o Do you feel you can maintain these changes?
o Have you met your goals?
o Have you discovered other goals that you want to continue to pursue?
o Is psychotherapy a useful tool for you to reach those goals?
o Would other treatment options better help you reach these goals?
The frequency and duration of psychotherapy depend on your goals and on the type of psychotherapy used. You may have learned what you need to know to modify your behaviors. You may have better control over reactions to stress or triggers for your depression. However, maintenance visits may be useful if you slip back to old patterns. In some situations, ongoing support of the therapist is key to maintaining your progress or your self-esteem. Or maintenance therapy may lead to further growth, enabling you to respond more effectively to life's challenges.
Decisions about stopping therapy are very often complicated. You may have developed a strong relationship with your therapist. Always realize that your therapist is a consultant who provides a service to you. You are free to decide whether or not the visits help you keep depression at bay.