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Question
Posted by: Anon | 2010/06/07

antidepressants

Hi CS

Is the protocol re 3 severe episodes of major depression = lifetime on antidepressants cast in stone? I am on Efexor 175 mg and Remeron 15mg (which I rely on particularly for sleep). I have tried to raise this with my shrink but she is averse to this (but I only see her every 2 months) but my psychologists who I see weekly is pro as she feels that I am stable and the depression has been in remission (with a few flutters) for 3 years. Also is the Remeron not something I could take symptomatically (ie when I cant sleep) rather than nightly as I am struggling with weight gain? Thanks.

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Our expert says:
Expert ImageCyberShrink

Nothing much is cast in stone. What happens within an expert community of specialists in a field is that after a long enough time for each to gather experience, they form a Consensus - a policy which most of the agree with. There will always be some who disagree. In this example, some would recommend long-term ADs after 2 clear episodes, some might wait longer.
But overall, the view is that after 3 episodes the likelihood of further episodes is high, and the long-term use of ADS should reduce that risk, perhaps reduce the sevesity of any episodes that do nonetheless arrive, and so on. It's a question of judgement, though, assessing the individual's particular history in terms of broad guidelines, rather than a blind application of rigid rules.
Which ADs would be the best for maintenance therapy, would still be a matter of opinion, not rules.
If someone has been stable for 2 or 3 years, it would be justifiable, after considering all the facts and risks, to try gradually reducing the ADs, and maintaining observation, so as to recognize if there are signs of a returning depression, so that treatment could be resumed, or if the person remains well, letting them remain drug-free but maintainin vigilence.
I'm not sure with your question about the Remeron. Any antidepressant has to be used in an appropriate dose regularly, daily, to produce a useful antidepressant effect. I wouldn't personally use Remeron simply for sedative side-effects and as a sleep aid - there are probebly cheaper and safer alternaives like Stilnox or its generic versions.

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Our users say:
Posted by: cybershrink | 2010/06/07

Nothing much is cast in stone. What happens within an expert community of specialists in a field is that after a long enough time for each to gather experience, they form a Consensus - a policy which most of the agree with. There will always be some who disagree. In this example, some would recommend long-term ADs after 2 clear episodes, some might wait longer.
But overall, the view is that after 3 episodes the likelihood of further episodes is high, and the long-term use of ADS should reduce that risk, perhaps reduce the sevesity of any episodes that do nonetheless arrive, and so on. It's a question of judgement, though, assessing the individual's particular history in terms of broad guidelines, rather than a blind application of rigid rules.
Which ADs would be the best for maintenance therapy, would still be a matter of opinion, not rules.
If someone has been stable for 2 or 3 years, it would be justifiable, after considering all the facts and risks, to try gradually reducing the ADs, and maintaining observation, so as to recognize if there are signs of a returning depression, so that treatment could be resumed, or if the person remains well, letting them remain drug-free but maintainin vigilence.
I'm not sure with your question about the Remeron. Any antidepressant has to be used in an appropriate dose regularly, daily, to produce a useful antidepressant effect. I wouldn't personally use Remeron simply for sedative side-effects and as a sleep aid - there are probebly cheaper and safer alternaives like Stilnox or its generic versions.

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