When deciding how long to continue an antidepressant and how closely to follow someone up, the strongest predictors of recurrence remain clinical. Several previous episodes, residual symptoms at remission, an early age at onset, a severe index episode and ongoing stressors all raise the risk. People with three or more episodes are usually advised to consider longer-term maintenance treatment.
- Count previous episodes and record them in the notes.
- Look for residual symptoms before calling a patient recovered.
- Discuss longer maintenance treatment after three or more episodes.
- Agree early warning signs and a plan to act on them.
Why it matters
Most of what can be predicted about relapse is already in the history.
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