A 52-year-old patient came to see me for a severe depressive episode triggered by a marital crisis. He had classic symptoms of major depression: persistent sadness, loss of pleasure, appetite and libido, relentless pessimism, and insomnia. I prescribed Zoloft and provided supportive therapy, and within six months, his depression had completely resolved despite ongoing marital difficulties.
Then, he asked me a crucial question: “Doctor, when can I stop taking Zoloft?” He felt back to his normal self, with no symptoms, and wasn’t fond of the reduced sex drive caused by the medication.
This question challenges the common misconception that psychiatric medications should be continued indefinitely once initiated. Surprisingly, this misconception is shared not only by the public but also by many psychiatrists.
In this particular case, the patient had only experienced one previous depressive episode in his early 20s, which resolved without treatment. Based on his history, I believed it was safe to taper off and discontinue Zoloft, closely monitoring his progress without any medication.
As psychiatrists, we are trained to diagnose and treat medical conditions, striving for full remission. However, we tend to overlook the art of “de-prescribing” — knowing when a drug or treatment has served its purpose and can be safely discontinued. This is often due to the assumption that certain conditions, such as depression, are chronic and necessitate lifelong therapy.
Contrary to popular belief, chronic diseases like depression can be intermittent and highly variable among individuals. For instance, if you have just recovered from your first episode of depression, the risk of experiencing another episode within the first year following stopping medication is roughly 33 to 50 percent. However, the lifetime risk of recurrence following one episode is approximately 60 percent, although that episode might be years away.
To gauge the need for continued treatment following one depressive episode, it is generally safe to consider stopping medication following a solid period of recovery, usually lasting six months to a year.
Nevertheless, there are exceptions to this rule. Individuals who have experienced a severe first episode involving a suicide attempt or significant impairment in functioning may face an unacceptable risk
