Despite being a very reasonable and simple request from my patients, I find this one of the more difficult questions to answer adequately. Why is this so? The answer lies in the reality that Psychiatry remains a relatively “soft”  science. As I have previously discussed, my discipline is not as clearly defined as found in specialties like endocrinology, cardiology, etc. I will do my best in providing some basic guidelines. More detailed information may be found at the American Psychiatric Association’s “Practice Guidelines.”

If one suffers from a major depressive disorder we recommend remaining on the medication 6 to 12 months after significant improvement. That is because there is a risk of recurrence even when one is feeling fine if medication is discontinued earlier than the 6 month interval. That being said, if the current episode of depression in the second or third lifetime experience with significant depression, serious consideration should be given to maintenance therapy for the purpose of preventing recurrent episodes. As discussed in the past, a history of cyclic depressions suggests the possibility of an underlying bipolar biology responsible for the depressive episodes and pharmacologic treatment may need to include an appropriate mood stabilizer.

The duration of treatment can also be influenced by the age of onset of the first depression. Onset at an earlier age requires that one be vigilant for future episodes and the need for pharmacologic preventive management. Late life depression, depressive episodes developing in the fifties or sixties can often be more complex because of the presence of non-psychiatric medical problems that may be playing a role. In addition, the biology of depression developing in an older brain may turn out to be fundamentally different from that of a younger brain. It is the late life depression that requires heightened vigilance towards non-psychiatric medical mimics, medical conditions that when treated directly may alleviate the “depressive” symptoms.

In previous articles we have reviewed the importance of determining the degree of life situational stressors that may have resulted in the current depression. Their presence does not rule out the importance of addressing biological underpinnings with medication. If one has a history of both spontaneous and stress-induced depressive episodes preventive efforts remain important. This is why a careful past history becomes critical.

Pharmacologic management of anxiety disorders becomes more complex. We do know that medications that address the brain’s serotonin system can be beneficial for a variety of anxiety disorders including obsessive compulsive, panic, generalized anxiety and post traumatic stress disorders. Maintenance therapy may be indicated as well. Benzodiazepine tranquilizers like diazepam (Valium), alprazolam (Xanax), lorazepam (Ativan), clonazepam (Klonopin), oxazepam (Serax), clordiazepate (Tranxene) and chlordiazepoxide (Librium) can be extraordinarily effective but recent research has raised concerns about their use and the development of Alzheimer’s dementia. Like other aspects of treatment in medicine, one has to consider the risks and the benefits of the treatment pursued.

It is most important to discuss the critical role that Cognitive Behavioral Therapy or CBT plays in the treatment of anxiety disorders. Successful completion of a course of CBT often shortens the course of medications and/or may make pharmacologic intervention unnecessary. CBT has the additional advantage of letting the anxiety sufferer feel proud in mastering the skill sets necessary for alleviating their symptoms. Unfortunately, the availability of cognitive behavioral therapists becomes a limiting factor.

As in other fields of medicine, recovery from psychiatric disorders also involves paying attention to basic day to day needs including proper balanced nutrition, adequate sleep, appropriate exercise regimens, pursuit of stress reducing activities and a balanced life program. I do hope that this brief article has helped to address some of the questions concerning medication therapy.