Most depressions and anxiety disorders respond well to treatment with specific medications. The principles of medication management involve reviewing your history, making a proper diagnosis, reviewing what medications you have taken in the past and their effects/side effects, what medications (including medications for medical disorders and over the counter medications) you are currently taking, determining if you are appropriate for psychotherapy alone, medication alone, or psychotherapy with medication, and then choosing an appropriate medication for you. Medication management involves, at first, frequent (weekly) return visits to monitor how you are responding, what side effects you may be experiencing, and adjusting the medication dose. Most often, we begin with a small dose in order to minimize side effects, and then increase the dose to the therapeutic range. Sometimes we need to add additional medications to counter side effects (such as adding a sedating medication if insomnia is a side effect). Medication management by itself (without psychotherapy) usually involves a brief visit and we try to extend the time between visits if you are responding and not experiencing significant side effects.
The general guidelines for treatment of depression with medication are to treat the episode until it resolves (remission) and then continue treatment for an additional 6 months or so (“continuation treatment”). Research studies demonstrate that continuation treatment greatly reduces the risk of return of depressive symptoms (“relapse”). For people who have recurrent depression or chronic forms of depression (lasting 2 years or longer), long term maintenance treatment is recommended to reduce the risk of future episodes (“recurrence”). Patients with bipolar depressions are usually treated with maintenance treatment.
We recommend that patients with depression monitor their moods (daily or weekly depending on the type of depression they have) to note any return of symptoms. Several mood rating scales have been researched and published, including the Patient Health Questionnaire 9 Items (PHQ 9) and the Quick Inventory of Depressive Symptomatology (QIDS). We also encourage patients to involve family members in determining the mood ratings, as often a return of mood symptoms may be more apparent to family members than to the patient.