Complete remission of symptoms and return to normal functioning are the therapy goals. For patients in their first episode of depression, treatment to remission may take up to several months and should be continued for a minimum of 9 to 12 months after remission.[165]National Institute for Health and Care Excellence. Depression in adults: treatment and management. Jun 2022 [internet publication].
https://www.nice.org.uk/guidance/ng222
[322]Kato M, Hori H, Inoue T, et al. Discontinuation of antidepressants after remission with antidepressant medication in major depressive disorder: a systematic review and meta-analysis. Mol Psychiatry. 2021 Jan;26(1):118-33.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7815511
http://www.ncbi.nlm.nih.gov/pubmed/32704061?tool=bestpractice.com
Depression lasting more than 12 months occurs in approximately 12% of patients according to community studies, and in up to 61% of patients treated in secondary care.[467]Verduijn J, Verhoeven JE, Milaneschi Y, et al. Reconsidering the prognosis of major depressive disorder across diagnostic boundaries: full recovery is the exception rather than the rule. BMC Med. 2017 Dec 12;15(1):215.
https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-017-0972-8
http://www.ncbi.nlm.nih.gov/pubmed/29228943?tool=bestpractice.com
Depression may be intermittent and recurrent across the lifespan.[468]Klein DN, Shankman SA, Rose S. Ten-year prospective follow-up study of the naturalistic course of dysthymic disorder and double depression. Am J Psychiatry. 2006 May;163(5):872-80.
https://psychiatryonline.org/doi/10.1176/ajp.2006.163.5.872
http://www.ncbi.nlm.nih.gov/pubmed/16648329?tool=bestpractice.com
For patients who are established on antidepressants clinical guidance supports consideration of prolonged antidepressant treatment and psychological therapy for relapse prevention, either alone or in combination.[165]National Institute for Health and Care Excellence. Depression in adults: treatment and management. Jun 2022 [internet publication].
https://www.nice.org.uk/guidance/ng222
[332]Bauer M, Severus E, Köhler S, et al.; World Federation of Societies of Biological Psychiatry (WFSBF) Task Force on Treatment Guidelines for Unipolar Depressive Disorders. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of unipolar depressive disorders, part 2: maintenance treatment of major depressive disorder - update 2015. World J Biol Psychiatry. 2015 Feb;16(2):76-95.
https://wfsbp.org/wp-content/uploads/2023/02/Bauer_et_al_2015.pdf
http://www.ncbi.nlm.nih.gov/pubmed/25677972?tool=bestpractice.com
Depression recurs in about one third of patients within 1 year of discontinuing treatment and in more than 50% of patients during their lifetime.[39]Remick RA. Diagnosis and management of depression in primary care: a clinical update and review. CMAJ. 2002 Nov 26;167(11):1253-60.
http://www.ncbi.nlm.nih.gov/pubmed/12451082?tool=bestpractice.com
Evidence that antidepressants can prevent relapse is unclear.[469]Cuijpers P, Geraedts AS, van Oppen P, et al. Interpersonal psychotherapy for depression: a meta-analysis. Am J Psychiatry. 2011 Jun;168(6):581-92.
http://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2010.10101411
http://www.ncbi.nlm.nih.gov/pubmed/21362740?tool=bestpractice.com
After 15 years, 87% will experience a recurrence. For patients with multiple recurrent depressive episodes, many experts advocate long-term maintenance therapy.[332]Bauer M, Severus E, Köhler S, et al.; World Federation of Societies of Biological Psychiatry (WFSBF) Task Force on Treatment Guidelines for Unipolar Depressive Disorders. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of unipolar depressive disorders, part 2: maintenance treatment of major depressive disorder - update 2015. World J Biol Psychiatry. 2015 Feb;16(2):76-95.
https://wfsbp.org/wp-content/uploads/2023/02/Bauer_et_al_2015.pdf
http://www.ncbi.nlm.nih.gov/pubmed/25677972?tool=bestpractice.com