Treatment of Major Depressive Disorder

Duration of Treatment

For patients with a first episode of major depressive disorder, treatment with sertraline should be continued for 4-9 months after achieving remission, while patients with recurrent depression should receive treatment for 2 years or longer to prevent relapse, as recommended by the American Academy of Family Physicians and the American College of Physicians 1, 2, 3, 4
The risk of recurrence increases with each episode, with a 50% risk after the first episode, 70% after the second episode, and 90% after the third episode, according to the American Academy of Family Physicians 1

Treatment duration varies depending on the episode of depression:

Episode	Treatment Duration
First episode	4-9 months after achieving remission
Recurrent depression (2+ episodes)	2 years or longer to prevent relapse
Persistent Depressive Disorder (PDD)	typically requires longer treatment duration due to its chronic nature

2, 1, 3, 4

The American College of Physicians recommends beginning assessment within 1-2 weeks of starting antidepressant therapy, with subsequent assessment at 4 weeks, and then every 3 months if stable, to evaluate initial therapeutic response and assess for side effects 2, 5
If inadequate response occurs within 6-8 weeks, treatment modification is recommended by the American College of Physicians, with consideration of switching to alternative antidepressants such as vortioxetine, and a minimum interval of 1 week between changes 2, 6
Regular monitoring is essential during treatment, with follow-up every 3 months to assess continued benefit and monitor for adverse effects, and close follow-up for at least 2-3 months after discontinuation due to high risk of relapse 2, 5, 7

Systematic reviews show that continued treatment with antidepressants after remission protects against recurrence and relapse, as reported by the American Academy of Family Physicians 1
The American College of Physicians defines the treatment of Major Depressive Disorder (MDD) as following three distinct phases:
Treatment success should be evaluated based on reduction in depressive symptoms, improvements in function and quality of life, and absence of significant side effects, using standardized tools to monitor changes in depressive symptoms and assess treatment response 2, 5, 7
The American College of Physicians recommends either cognitive behavioral therapy (CBT) or second-generation antidepressants as initial treatment for MDD, considering factors such as adverse effect profiles, cost, accessibility, and patient preferences 2, 3
Bupropion SR is less likely to cause sexual dysfunction compared to SSRIs, making it a suitable option for patients with depression, and may be beneficial for patients with comorbid medical conditions, including those who need assistance with smoking cessation 1, 8
Patients with multiple previous episodes of depression, severe depressive symptoms, comorbid medical or psychiatric conditions, or residual symptoms after acute treatment may benefit from extended treatment durations, as identified by the American College of Physicians and the American Academy of Family Physicians 2, 1