Remission / Continuation Phase Treatment

Wonderful — Your patient is in remission.

Here are some recommendations regarding Continuation Phase Treatment:

• According to the 2023 CANMAT guidelines patients without risk factors for recurrence (see below) who receive pharmacotherapy during acute phase treatment should continue their treatment for AT LEAST 9 to 12 months after symptom remission, at the same dose that led to a therapeutic response
• Patients with a first episode of MDD who enter remission should be followed every 3 months for the first year and at the end of 9 to 12 months should be evaluated for slow tapering and discontinuation of antidepressant medication (see antidepressant table and go to STOP column for guidance as to how to do this)
• CANMAT recommends that for those with risk factors for recurrence antidepressants should be continued 2  years or longer
• Risk factors for recurrence include:
  • frequent, recurrent episodes
  • severe episodes (psychosis, severe impairment, suicidality)
  • chronic episodes
  • presence of comorbidity (psychiatric or other medical conditions)
  • presence of residual symptoms
  • difficult-to-treat episodes
  • poor social support
  • persistent stressful life events
• For patients who were augmented with antipsychotics, consider gradually tapering and discontinuing the antipsychotics after 6-9 months.