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Looking at Depression Treatment in the Long Run

Many depressed patients have difficulty continuing treatment even after they get past the initial stigma of taking a brain pill. One thing that preys on their minds is the worry that once they’ve committed to taking anti-depressants, they’ll be on them permanently.

“‘Will I be on this forever?’ is probably the most common question I get,” said Alpert. Unfortunately, Alpert’s response is not that comforting.

A patient who comes in after three or four months of depression is typically treated for about a year beyond “remission,” but has a 50% change of another bout of depression. A patient who has had two bouts of depression has a 75% chance of requiring treatment for a third bout. And those who’ve been depressed on three or more occasions are very likely to relapse if they go off therapy. The longer you’ve been depressed, in short, the likelier you are to relapse at some point after stopping antidepressants.

“For somebody with a very chronic depression or a very severe depression -- for example they’ve made attempts on their life or been psychotic -- typically we’ll treat them a much longer time,” says Alpert. “But if you’ve been doing really well the last 5 years and you’re in stable position with good support we might very cautiously taper antidepressant. In some cases, each time we do that they plunge into severe depression. In those cases, we say the risks of staying on are outweighed by the risks of coming out.”

Moving Beyond the Barriers to Recovery

The best way to get past the barriers to recovery from depression is to learn as much as you can about the treatments that help. Here are some questions to ask your doctor about your antidepressant and what to expect:

  • What is this medicine supposed to do?
  • How will I know when it’s doing it?
  • How will it affect me overall? Will it change me?
  • When should I start seeing results?
  • What happens if I don’t see the expected results?
  • Is there someone I can call in your office if I have questions I need to ask?

It also helps to talk with your psychiatrist and with your mental health counselor about your feelings concerning depression and what other people may have said to you. Your mental health team can help you sort out what’s true from what isn’t. They can also help you understand that depression is an illness just like high blood pressure or heart disease. It is not your fault, nor is it a character flaw. And there are very effective treatments that can address it.

Is Your Antidepressant Working?

How long does it take? What should you expect?
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