Our expert says:
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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