Medication has provided my spouse with the capacity to function at his highest level. He has been able to work for over 20 years without having to take a medical leave and to lead a full life, including time with family and friends.
He remains in therapy, and his medications are adjusted as needed. For us, it is not a question of whether he should remain on medication. Like a diabetic who needs to monitor blood sugar levels and adjust insulin doses to feel well and take an active role in life, a person who suffers from chronic depression can remain well with appropriate and consistent treatment.
It is important to understand that antidepressant therapy is used for treatment of the acute illness and to maintain remission of the depression. Remission may be partial or full and can occur within 4 to 6 weeks after the initiation of medication.
Full remission has occurred when there are no longer any symptoms. This is not, however, a good time to stop the medication. Many people stop their antidepressant treatment prematurely because they feel better.
It may be thought that the medication is not needed anymore or even questioned whether the medication had anything to do at all with the improvement (particularly if there were no side effects).
Close monitoring by your doctor can help to address questions of efficacy as well as to provide the feedback as to level of improvement. When medication is discontinued prematurely, a relapse or recurrence is likely to occur soon thereafter. A relapse occurs if there is a return of depression within 6 months of remission of symptoms.
Recurrence occurs if depression returns during the period of recovery, which is after 6 months of remission. Statistically speaking, after remission of a depressive episode, the highest risk for recurrence is within the first year.
The standard recommendation therefore is to continue antidepressant therapy for 9 months to 1 year after complete remission of symptoms. After one episode of depression, the risk for recurrence after a year in remission is similar to the baseline risk for depression.
The more episodes of depression that occur over time, however, the higher the risk for future episodes. In fact, a history of three or more episodes places patients at a greater than 80% risk for recurrence. Therefore after two or more episodes (depending on severity), your doctor may recommend indefinite treatment with an antidepressant to reduce your risk for recurrence.