Acute Phase:

Single or recurrent episode
of major depression

1. Select antidepressant
2. Start at sub-therapeutic dose to minimize risk of side effects
3. Increase at roughly weekly intervals to therapeutic dose.
4. Refer to psychiatrist instead or after two unsuccessful medication trials

Goal of acute phase
treatment achieved

1. Continue same dose required to achieve remission during
   acute phase
2. Monitor for relapse
3. If relapse occurs increase dose, initiate augmentation strategy, or switch to new agent

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

1. Continue same dose used successfully during
   continuation phase
2. Monitor for recurrence
3. Increase dose, initiate augmentation strategy, or switch to a new agent if there is a recurrent episode