Ordinarily, there should be some degree of response after 4 weeks of medication or 4-6 weeks of a psychological therapy or combination of psychological and medication therapy. If not, NICE is advising to check whether there may be any other elements in the patient’s life that might explain why the treatment is not working, or if there have been problems adhering to the treatment plan.4
This may then require a discussion on other treatment options such as swapping from medication to a psychological therapy or vice versa, a combination of both, a change in the dose or type of antidepressant, or a change in the psychological therapy.
Patients should be made aware that continuing treatment after full or partial remission may reduce their risk of relapse and may help them stay well. However, there should be a shared decision on whether to continue a treatment based on their clinical needs and preferences.
If they chose to discontinue antidepressant medication, they should be given help to stop and be advised to seek help as soon as possible if depression symptoms return or residual symptoms worsen.