Continuation of Treatment

As noted, physicians are encouraged to push treatment until symptoms remit, maximum doses are achieved, or side effects become intolerable. Once symptoms remit, medications should continue for 6 to 9 months because risk of relapse is greater if patients discontinue medications prematurely (AHCPR, 1999; Geddes et al., 2003). Patients who have had multiple episodes of depression should continue pharma-cotherapy because lifetime relapse rates for such patients are 50% to 85% (Eaton et al., 2008), and risk of recurrence increases by 16% with each successive episode (Solomon et al., 2000). Ongoing treatment should also be considered for patients who experienced severe functional impairment, severe suicidal ideation, or serious suicide attempts.

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