Depression experts and psychopharmacologists have conceptualized the treatment of depression into three parts: the acute phase, the continuation phase, and the maintenance phase.
The acute phase of treatment begins when the patient appears in the doctor’s office showing signs or complaining of symptoms of depression. At (his point, the immediate goal is to alleviate the symptoms as quickly as possible. This might mean medication, some form of psychotherapy, or a combination of the two.
The continuation or middle phase of treatment begins once the patient has responded to treatment. Too frequently, both the patient and the physician, believing that an improvement of symptoms indicates that the depression has been defeated, discontinue the medication. This is a mistake. Although the depression may have retreated, often it has not yet been conquered. It is simply in remission. If the patient is taken off medication too soon, the depression may attack again. Even with medication, relapses are common, which is why it is important to continue treatment during this phase. To prevent a relapse after the symptoms have disappeared, one study found that patients need to continue taking medication for four or five months.
During the third or maintenance phase of treatment, the object is to prevent another acute episode of depression. The way to do this is by maintaining the medication for as long as several years—or a lifetime. Patients often don’t want to do this, sometimes because they just don’t like the idea of taking drugs and they feel that they are “cured”. Yet the unfortunate fact is that for most people, depression is not a once-in-a-lifetime event More than 50% of patients suffering from a first bout of major depression will have it again at some point, and 80% to 90% of patients having a second episode will go on to experience a third. With disorders such as major depression, preventive medicine means long-term maintenance medication.
Emerging evidence also suggests that many depressed patients do better if medication is combined with three or four months of individual psychotherapy, cognitive therapy, or behavioral therapy. When the therapy comes to an end, however, the medication should continue if the depression is recurrent.
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