People who have remitted from depression when treated with antidepressants alone should be assessed for relapse risk (see panel).4
Those at higher risk should be asked to consider continuing with their antidepressant medication for up to two years maintaining the same dose (if possible) to prevent relapse, or to combine it with group CBT or mindfulness-based CBT (MCBT). This discussion needs to raise the potential risks of long-term antidepressant use before the patient decides.
Those wanting to stop their medication should be asked to consider group CBT or MCBT. Any CBT for relapse prevention should have an explicit focus on the development of relapse prevention skills and what is needed to stay well.
 
Factors that increase the likelihood of relapse after treatment for depression include:4
·       a history of recurrent episodes of depression, especially within the past two years
·       a history of incomplete response to previous treatment, including residual symptoms
·       unhelpful coping styles such as avoidance or repetitive negative thought patterns (rumination)
·       a history of severe depression
·       other chronic comorbidities
·       personal, social or environmental factors that contributed to their depression that are still present.
 
This article was written in February 2022 using the draft NICE guideline out for consultation between November 2021 and January 2022. Content may therefore differ from the finalised NICE guideline, expected to be published on12 May 2022.4