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Algorithm for antidepressant medication monotherapy during the continuation/maintenance phase for adults with unipolar major depression

Algorithm for antidepressant medication monotherapy during the continuation/maintenance phase for adults with unipolar major depression
* Response is defined as reduction of baseline symptoms ≥50 percent.
¶ For patients who do not respond to initial therapy, refer to topic for treatment resistant depression.
Δ Complicated episodes of unipolar major depression include episodes with suicidal ideation, psychotic features, psychomotor retardation, or severe impairment, and episodes that require more than six months of acute treatment to achieve response.
Risk of relapse is higher in patients with:
  • Childhood maltreatment.
  • Early age of onset of unipolar major depression (eg, ≤18 to 21 years of age).
  • A lifetime history of at least two of three major depressive episodes.
  • Persistent or emergent residual depressive symptoms, especially sleep disturbances and/or suicidal ideation.
  • Comorbid anxiety disorders.
  • Prominent depressive cognitions, such as hopelessness or rumination.
  • Psychosocial stressors or impairment.
§ Refer to topic on discontinuing antidepressants.
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