Staying Well Once Your Depression Is Treated

[David Baxter PhD]

Staying Well Once Your Depression Is Treated
July 13, 2005
InteliHealth

Although some people have only one episode of depression, many people have ongoing problems. That's why doctors recommend that treatment continue even if you start to feel better.

This is sometimes called "maintenance" treatment. Doctors advise people, especially those who are at high risk for a recurrence of depression, to continue with treatment. 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 the same treatment that helped you in the first place. Drug treatment and psychotherapy may both play a role.

Because treating depression often involves numerous health professionals (psychiatrist, psychotherapist, counselor, primary-care doctor), you may want to choose one person to act as your consultant to your treatment. In the best circumstance, this person can discuss the pros and cons of different maintenance approaches and help you to decide whether to keep using drug treatment or how long to continue psychotherapy.

Ongoing Drug Treatment
Ask yourself the following two questions:

• If I continue using drug treatment, how unpleasant are the side effects?
• If I stop using drug treatment, what is the risk that my depression will return?

Weighing your options. If your drug treatment has relieved your depression, and you have been able to handle any side effects, your doctor will probably suggest that you continue your drug treatment for at least six to nine months. At the end of this time, you may choose to continue your drug treatment (because it was helpful and easy to take) or you may prefer to see what happens if you stop the drug. If you stop, there is a chance that your depression will return. Discuss your specific risks 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 also reverse these symptoms.

The risk of depression coming back. As the risk of recurrence increases, more people decide to continue drug treatment. Depression is likely to recur when:

• 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 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 many people try taking a lower dose during maintenance treatment, 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.

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 a great idea.

Ongoing Psychotherapy
If you have been using therapy to treat your depression, 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 a useful tool for me to reach my goals?
• Would other treatment options better help me reach my goals?

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. You may learn in just a few sessions all that you need to know to make necessary changes.

Follow-up visits may be useful if you slip back into old patterns. 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.

Deciding whether 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 the visits are helping you to keep your depression at bay.