From the Guidelines
For depression follow-up, I strongly recommend regular assessments and adjustments to treatment as needed, with a focus on monitoring patient status, therapeutic response, and adverse effects of antidepressant therapy on a regular basis, beginning within 1 to 2 weeks of initiation of therapy. This approach is supported by the American College of Physicians, which recommends regular assessments and modifications to treatment if the patient does not have an adequate response to pharmacotherapy within 6 to 8 weeks of the initiation of therapy for major depressive disorder 1.
Key aspects of depression follow-up include:
- Regular appointments with a healthcare provider every 2-4 weeks initially, then every 3-6 months once symptoms improve
- Continuing prescribed antidepressant medication for at least 6-12 months after feeling better to prevent relapse
- Combining medication with cognitive behavioral therapy (CBT) for better outcomes
- Tracking symptoms using a scale like the PHQ-9 to monitor progress
- Maintaining healthy lifestyle habits, including regular exercise, consistent sleep patterns, and social connection
It is also essential to reassess and adjust treatment as needed, particularly if symptoms persist or worsen, as recommended by the American Society of Clinical Oncology 1. This may involve altering the treatment course, such as adding a psychological or pharmacologic intervention, changing the specific medication, or referring to individual psychotherapy. Regular monitoring and timely modifications to the treatment plan are crucial to ensure effective management of depression and prevent relapse.
From the FDA Drug Label
It is generally agreed that acute episodes of major depressive disorder require several months or longer of sustained pharmacologic therapy beyond response to the acute episode Systematic evaluation of sertraline has demonstrated that its antidepressant efficacy is maintained for periods of up to 44 weeks following 8 weeks of initial treatment at a dose of 50 to 200 mg/day (mean dose of 70 mg/day) Patients should be periodically reassessed to determine the need for maintenance treatment
Follow-up for Depression:
- Patients with major depressive disorder should be treated for several months or longer after the initial response.
- The antidepressant efficacy of sertraline is maintained for up to 44 weeks.
- Patients should be periodically reassessed to determine the need for maintenance treatment 2
From the Research
Importance of Follow-up in Depression Treatment
- Systematic follow-up is a crucial component of quality care for depressed patients, as it can significantly improve patient outcomes 3.
- A study found that patients who received a visual self-assessment card to track their daily mood changes and remind them of their follow-up appointment were more likely to attend their follow-up appointment 4.
Antidepressant Effectiveness and Tolerability
- Selective serotonin-reuptake inhibitors (SSRIs) are effective for treating depression and have a good side-effect profile, tolerability, and safety in overdose 5.
- A network meta-analysis found that SSRIs, such as sertraline and paroxetine, have the best benefit-risk profile and are suitable as first-line treatments for individuals with comorbid physical conditions and depressive disorders 6.
- However, the strength of evidence for the effectiveness of antidepressants in treating accompanying symptoms of depression, such as anxiety and insomnia, is limited and often weakened by inconsistency and imprecision 7.
Strategies to Improve Follow-up Attendance
- Using visual self-assessment cards to remind patients of their follow-up appointments can increase attendance rates 4.
- Efforts to increase compliance with follow-up appointments should be a cornerstone of mental health integration approaches, and cost-effective interventions should be explored to optimize the use of reminders and promote compliance 4.