WHAT HAPPENS IF THE DOSAGE IS LOWERED?

March 23rd, 2009

About four to six months after the depression has been alleviated, and assuming the symptoms have not returned, the decision could be made to lower the dosage. If the depression does not return, fine. However, if the patient slides back into depression on the lower dose, it is better to restore the full amount as a maintenance dose. In many patients with recurrent unipolar depression, the smaller dose will protect the patient from immediate relapse, but in some the smaller dose is insufficient and future recurrent depressions eventually reemerge. This simply tells the physician and the patient that the maintenance dose needs to be kept at a higher level, often the same level required to alleviate the acute depressive episode. This general principle is also true for lithium and other antidepressant drugs.

A certain number of depressed patients, year after year, come to the office in a depression, take an antidepressant, and then once the depression is alleviated, stop their office visits and go off the drug on their own. In these instances, after a relapse, the antidepressant usually has to be reintroduced at the previous therapeutic level or at an even higher level before the depression again disappears.