Table 2: Phases of treatment with antidepressant medication (adapted from reference 21)

Table 2:
Phases of Treatment with Antidepressant Medication (Adapted from Reference 21)
Acute Phase:
Typical Duration	Indications for Treatment	Goals	Strategy
4-12 weeks	Single or recurrent episode of major depression	Remission of index episode	Select antidepressant Start at sub-therapeutic dose to minimize risk of side effects Increase at roughly weekly intervals to therapeutic dose. Refer to psychiatrist instead or after two unsuccessful medication trials
Continuation Phase:
4-6 months	Goal of acute phase treatment achieved	Continued remission. Prevent relapse (ie, return of the index episode)	Continue same dose required to achieve remission during acute phase Monitor for relapse If relapse occurs increase dose, initiate augmentation strategy, or switch to new agent
Maintenance Phase:
> 9-12 months. Optimal duration uncertain	1. Three prior episodes of depression or 2. Two prior episodes plus: First degree relative with major mood disorder; Recurrence within one year of prior effective treatment; Onset of first episode before age 20; or Both episodes were severe, sudden, or life threatening in the past 3 years	Prevent recurrence of depression	Continue same dose used successfully during continuation phase Monitor for recurrence Increase dose, initiate augmentation strategy, or switch to a new agent if there is a recurrent episode

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