When can a patient with depression and anxiety who has been stable on sertraline 50‑100 mg daily (or venlafaxine XR 75 mg daily) and buspirone 10‑20 mg three times daily for at least six weeks be discharged from outpatient mental‑health services, considering symptom severity (PHQ‑9 ≤ 9, GAD‑7 ≤ 9) stable for two visits 2–4 weeks apart, therapeutic medication dose for ≥4 weeks, no active suicidal or homicidal ideation, completion of a safety plan, understanding of relapse‑prevention strategies, and a scheduled follow‑up within 1–2 weeks plus crisis resource access?

Discharge Readiness from Outpatient Mental Health Services for Depression and Anxiety

A patient with depression and anxiety who has achieved PHQ-9 ≤ 9 and GAD-7 ≤ 9 scores stable for two consecutive visits 2–4 weeks apart, maintained on therapeutic medication doses for ≥4 weeks, with no suicidal/homicidal ideation, completed safety planning, and scheduled follow-up can be safely discharged from specialized outpatient mental health services to primary care management. 1

Clinical Stability Criteria for Discharge

Your patient meets the evidence-based threshold for discharge based on validated symptom severity measures:

• PHQ-9 ≤ 9 indicates mild or minimal depressive symptoms, which falls below the moderate symptom threshold (PHQ-9: 10-14) that would require ongoing mental health specialty intervention 1
• GAD-7 ≤ 9 indicates mild or minimal anxiety symptoms, similarly below the moderate threshold (GAD-7: 10-14) requiring specialty care 2, 1
• Stability across two visits 2–4 weeks apart demonstrates sustained symptom control rather than transient improvement 3

Medication Optimization Confirmation

The patient's medication regimen meets duration and dosing requirements:

• Therapeutic doses maintained for ≥4 weeks aligns with the 4-week assessment point recommended for evaluating treatment response 3
• Sertraline 50-100 mg daily or venlafaxine XR 75 mg daily represents adequate first-line antidepressant dosing for GAD and depression 4, 5, 6
• Buspirone 10-20 mg three times daily provides appropriate anxiolytic augmentation, though long-term benzodiazepines should be avoided due to tolerance and dependence risks 4, 6

Safety and Risk Mitigation Requirements

Critical safety elements must be documented before discharge:

• No active suicidal or homicidal ideation eliminates the need for emergency psychiatric evaluation, which would be mandatory if PHQ-9 item 9 were endorsed at any frequency 1
• Completed safety plan provides structured crisis response strategies 2
• Crisis resource access ensures immediate intervention availability if symptoms worsen 2

Transition Planning Algorithm

Immediate Post-Discharge (1–2 weeks):

• Schedule follow-up within 1–2 weeks with primary care or continuing mental health provider to confirm stability 2
• This rapid follow-up mirrors the 48-hour recommendation for high-risk medical discharges and prevents deterioration 2

Ongoing Monitoring (2–4 months):

• Continue PHQ-9 and GAD-7 screening at each visit to detect early symptom recurrence 3, 1
• Reassess at 4 and 8 weeks if any medication adjustments are made 3
• Schedule visits every 3–4 months once sustained remission is established 7

Long-Term Maintenance (6–12 months):

• Maintain pharmacotherapy for at least 6 months after symptom resolution based on relapse-prevention data showing GAD's chronic, fluctuating course 5, 6
• Consider continuation for 12+ months given that 40% of GAD patients experience illness lasting >5 years 4

Relapse Prevention Education

Essential patient education components before discharge:

• Recognition of early warning signs: Return of excessive worry, sleep disturbance, irritability, or concentration difficulties that characterized their initial presentation 2
• Medication adherence strategies: Verify understanding of dosing schedule and importance of continued treatment even when feeling well 3
• When to seek urgent care: PHQ-9 >10, GAD-7 >10, or any suicidal ideation warrants immediate contact with healthcare provider 1

Common Pitfalls to Avoid

• Don't discharge based solely on patient self-report without validated screening tools – PHQ-9 and GAD-7 scores provide objective severity measurement 1
• Don't assume stability after a single improved visit – require two consecutive assessments to confirm sustained response 3
• Don't discontinue medications prematurely – GAD requires long-term treatment given its chronic nature, and early discontinuation increases relapse risk 5, 6
• Don't discharge without confirming follow-up appointments are scheduled – gaps in care increase rehospitalization and adverse outcomes 2
• Don't overlook comorbid conditions – screen for substance use disorders and ensure connection to appropriate behavioral health services if needed 2

Specialty Re-referral Triggers

Criteria requiring return to specialized mental health services:

• PHQ-9 ≥10 or GAD-7 ≥10 indicating moderate symptoms 1
• PHQ-9 ≥15 or GAD-7 ≥15 requiring immediate psychiatry/psychology referral for severe symptoms 1
• Treatment resistance defined as inadequate response after 8 weeks of optimized pharmacotherapy 3
• New suicidal ideation or other safety concerns 1
• Functional impairment despite symptom scores in mild range 2

Psychotherapy Considerations

• Cognitive Behavioral Therapy (CBT) gains may be maintained for up to 1 year after a 12-week course, supporting discharge if CBT was completed during treatment 4, 6
• Consider CBT referral before discharge if not already provided, as it offers sustained benefit and may reduce relapse risk 6