Treatment phases

Kurt B. Stage, consultant, psychiatrist

You need to be aware of the fact that your depression can recur if your treatment is interrupted too early. We therefore divide the treatment of depression into three phases:

• acute treatment
• maintenance treatment
• preventive treatment

Acute treatment

The period from the start of your treatment until the depressive symptoms disappear is called the acute treatment. After the acute treatment you will feel completely well. The acute treatment typically lasts one to two months.

It is important to remember that the symptoms disappear gradually over several weeks. We strongly advice you not to interrupt your treatment just because you haven't felt any effects after one week. Have plenty of patience - that is the best for yourself.

Your family will often notice the effect of your treatment before you yourself notice it. Your should therefore listen to them.

After 4-6 weeks of treatment the effect of the treatment is at its maximum, and now you will definitely be able to tell that you are feeling better.

Maintenance treatment

After a good acute treatment you will feel completely well. Your mood, energy and interest in the people around you has returned. You will be able to resume work and other activities. You can live your life the way you used to before you got your depression.

It is so important that you don't get a relapse, i.e. that the depression recurs. The best way of avoiding that is to continue your treatment with antidepressants, taking the same dose as in the acute treatment.

Continue taking your medicine

Depression is a serious and painful disease, and it doesn't disappear of its own accord after a week under the duvet. If you don't receive treatment for your depression, it will last between 6 and 12 months. That is an awful long time and causes great suffering.

We therefore cannot repeat it often enough. If you stop taking your medicine during this period, you risk becoming depressed again.

We therefore advice you to continue with your treatment and keep the dose unchanged until your depression would have ceased of its own accord - i.e. approximately a year after your symptoms have disappeared.

If your treatment needs to be stopped after a year, we then recommend that you gradually reduce the antidepressants over one to two months. An abrupt cessation of antidepressants can unfortunately cause you to relapse. And you definitely mustn't run any risk, when it concerns something so important in your life!

Preventive treatment

After your maintenance treatment you and your doctor must decide whether or not you need to continue with preventive treatment.

If you have had one depression, the risk of developing a new depression at a later stage is approximately 50%. In this case your preventive treatment should last a year. If you have had three or four depressions, the risk of developing a new one is unfortunately very great (90%). Your preventive treatment should then last at least 5 years and in severe cases for the rest of your life.

Your treatment should be identical in terms of medicine type and dose to the one that was effective in your acute treatment. During your preventive treatment, you can lead a normal life and look after your family and carry on with your education and work.

Can be permanent

The goal of preventive treatment is to avoid new depressive episodes. If you have had several depressions, the preventive treatment is especially important, as the more depressions you have had, the easier it is to develop a new one.

Preventive treatment is long - in some cases lifelong. You might regard this as a negative thing but just think about what you gain from the treatment: that you might avoid developing another depression again ever.