How Long Do I Have to Take This? What the Guidelines Actually Say About Antidepressant Duration

There is no single stop date for an antidepressant. Many people continue treatment for months after they are fully well. Some continue for years. Some choose treatment with no preset end date and review it at regular visits. The right answer starts with what happened before treatment and how fully you recovered, then weighs relapse prevention against side effects, burden, and your preferences.

This article helps you prepare for that review. It does not tell you to keep taking or stop a medicine on your own.

Key takeaways

• Count continuation time from remission, not from the first pill or first sign of improvement.
• Past episodes matter, but no episode count automatically means lifelong medication.
• “Indefinite” treatment means no preset stop date with regular review. It does not mean the decision can never change.

Zoom

Start the clock in the right place

Response means symptoms have improved in a meaningful way. You may be functioning better but still have important symptoms. Remission means symptoms are minimal enough that the episode is no longer fully active. Recovery means remission has held over time. Relapse is a return of the same episode before recovery is secure. Recurrence is a new episode after recovery.

Continuation guidance usually starts after remission. If you improved two months after starting a medicine, those first two months were acute treatment. They do not usually count as two months of treatment after remission.

Full remission matters because leftover symptoms can raise the chance of later difficulty. Sleep may be better while interest, energy, concentration, or hope is still low. That is a reason to reassess treatment, not simply start a countdown.

Continuation and maintenance are different phases

The continuation phase aims to keep a recently improved episode from returning. The maintenance phase aims to prevent future episodes when the expected risk and consequences justify ongoing treatment.

Neither phrase means “for life.” A maintenance plan can be reviewed and changed. It can include medication, psychotherapy, sleep and substance-use work, relapse-prevention skills, and faster access to care if warning signs return.

Medication is not the only way to lower relapse risk. NICE describes three paths for people who reached remission on medication alone and are at higher risk. They can continue the antidepressant at the dose that produced remission. They can switch to group cognitive behavioral therapy or mindfulness-based cognitive therapy. Or they can do both.1

What current guidance says

Guidelines agree on the decision factors more than on one exact duration.

These organizations are easy to confuse. The American Psychiatric Association represents psychiatry. The American Psychological Association represents psychology. Their guidance, dates, and update status are not interchangeable.3

The table’s duration language comes from NICE, CANMAT, and VA/DoD.145 NICE and VA/DoD both describe at least six months after remission. CANMAT recommends 6 to 12 months, and 2 years or more when risk factors for recurrence are present.

Guidelines also use these words differently. CANMAT calls the whole period after remission “maintenance.” VA/DoD and many United States clinicians call the first stretch “continuation.” The labels differ. The idea is the same.

They also disagree in one small but real way. VA/DoD points to the largest review in this area, which pooled 54 randomized trials and 9,268 patients. It found six months of continuation treatment was already long enough to show the relapse-prevention benefit. Stretching to nine or 12 months did not add more.5 CANMAT read newer evidence and concluded the opposite: extending to 6 to 12 months after remission does add benefit compared with stopping before six months.4

Two careful groups read the evidence and landed a few months apart. Notice what they do not dispute: both found that continuing treatment after remission lowers relapse risk. VA/DoD notes that three reviews found continuation cut relapse rates by roughly 70 percent compared with placebo.5 That is a large relative reduction, though what it is worth to one person depends on how high their risk was to begin with.

The argument is about how many months, not about whether continuing helps. Treat any published number as a starting point for your review, not an expiration date.

What can push the decision toward longer treatment

The case for longer treatment may become stronger when several of these are present:

• more than one well-documented depressive episode;
• a chronic or very long episode;
• residual symptoms rather than full remission;
• a history of childhood maltreatment or abuse;
• a severe episode, psychosis, catatonia, major self-neglect, or serious suicide risk;
• an early age at first episode or short time between episodes;
• a prior relapse after stopping an effective treatment;
• anxiety, substance use, medical illness, or another condition that complicates recovery;
• ongoing threat, unstable housing, major caregiving strain, poor sleep, or limited access to rapid follow-up;
• a strong family history or another clinical feature that may raise concern.

Some predictors have stronger and more consistent support than others. In the CANMAT review, persistent residual symptoms and a history of childhood maltreatment or abuse had the most robust evidence. Other factors on the list, including the number of past episodes, how long an episode lasted, and how severe it was, had weaker support.4 That does not make them meaningless. A list is not a calculator.

The likely harm of a relapse also matters. A return of depression may threaten work or school for one person and create immediate nutrition, psychosis, or suicide risk for another.

What may support a monitored stopping conversation

A discussion may be more reasonable when remission is full and sustained, this was a first or less recurrent episode, current life is relatively stable, follow-up is reliable, and there is a clear early-warning plan. Burdensome sexual effects, emotional blunting, weight or metabolic effects, pregnancy planning, cost, monitoring, or pill burden may also shift the balance.

These are discussion points, not eligibility rules. A first episode can be severe. A person with several episodes may still prefer a supervised attempt to stop. Patient preference belongs in the decision because the burdens are lived by the patient.

What ANTLER can and cannot tell you

ANTLER enrolled 478 adults in UK primary care. All were taking citalopram, fluoxetine, sertraline, or mirtazapine, and each had either at least two past depressive episodes or at least two years of antidepressant treatment. All felt well enough to consider stopping. At 52 weeks, 92 of 238 people assigned to maintenance had relapsed, compared with 135 of 240 assigned to taper and placebo. That is 39 percent versus 56 percent, with a hazard ratio of 2.06.6

Read that in both directions. Continued medication prevented relapse for some people in this selected group. But most people who stopped did relapse within the year, and many who kept taking their medication relapsed anyway. The trial does not show that everyone relapses after stopping, or that everyone benefits forever.

More people assigned to discontinue stopped taking their study capsules, and withdrawal symptoms were more common in that group. Early withdrawal and early relapse can resemble each other, which makes the first weeks after a change hard to read without support.

The trial studied only four medicines. Its participants were about 94 percent White, mostly middle-aged or older, and all were in UK primary care. That is a narrow slice of the people who take antidepressants.

What newer deprescribing evidence adds

A 2026 network meta-analysis combined 76 randomized trials with 17,379 participants who had remitted depression or anxiety. About four in five of those trials studied depression. Compared with abrupt discontinuation, four approaches were linked with fewer relapses: continuing medication, continuing medication plus psychological support, continuing at a reduced dose, and slow tapering plus psychological support. Slow tapering by itself was not clearly different from abrupt stopping in the network estimate.7

That result does not prove slow tapering is useless. Trials used different definitions and often measured withdrawal poorly. Some comparisons were indirect, and the certainty of the evidence varied from moderate to very low.

The practical signal is that stopping well is more than reducing milligrams. The tapering approach that worked here was the one paired with psychological support. Monitoring, relapse-prevention skills, and quick access to reassessment appear to be part of what makes a taper hold.

The cost of each choice

Continuing may preserve a benefit, lower relapse risk, and avoid withdrawal. It may also continue sexual effects, emotional flattening, sleep problems, weight or metabolic burden, cost, monitoring, or daily reminders of illness. The profile varies by medicine and person.

Stopping may reduce some burdens and clarify whether the medicine is still needed. It can also bring withdrawal, relapse, or both. A person may need more visits, therapy, family support, or time away from other demands during the transition.

No option is risk-free. The goal is not to prove that medication is good or bad. It is to identify which set of risks and benefits fits your history and values now.

Build a review plan even if you continue

NICE advises reviewing antidepressants used for relapse prevention at least every six months.1 A useful review covers:

• current symptoms and function, including interest and pleasure;
• a validated symptom rating scale, so change is measured rather than guessed;
• side effects, sexual function, weight or metabolic concerns, and other burdens;
• missed doses and what made them hard, without blame;
• sleep, alcohol, substances, medical illness, and major stress;
• psychotherapy or relapse-prevention skills;
• personal early warning signs;
• who will notice a change and how quickly the team can respond;
• whether the original diagnosis still fits, including any history of mania or hypomania.

If the decision is to continue with no preset stop date, set the next review date. “Indefinite” should never mean “never discussed again.” If the decision is to stop, use a separate individualized taper plan.

When to get help sooner

Seek prompt reassessment for a rapid return of hopelessness, major loss of function, inability to eat or drink, severe agitation, marked activation, new signs of mania, psychosis, or suicidal thinking. Do not wait for a planned maintenance visit if safety or basic care is changing.

If you may act on thoughts of suicide, or cannot stay safe, call or text 988 in the United States. Call 911 or go to the nearest emergency department for immediate danger.

What to do next

Bring your remission date, episode history, current benefits, current burdens, and early warning signs to one focused medication review. End that visit with a decision, a review date, and a written follow-up plan.

Frequently asked questions

Does one episode mean six months of medicine?

Not automatically. NICE and VA/DoD describe at least six months of treatment after remission, and CANMAT recommends 6 to 12 months, but severity, residual symptoms, follow-up, burdens, and preference can change the plan.

Do three episodes mean medication for life?

No episode count creates an automatic lifetime rule. A recurrent course may support longer treatment, with periodic review.

What does indefinite treatment mean?

It means there is no preset stop date. Benefits, burdens, and goals should still be reviewed.

Can therapy help if I stop?

Relapse-prevention psychotherapy and ongoing support may help, but they do not remove withdrawal or relapse risk for everyone.

This article is for education, not personal medical advice. Do not start, stop, restart, or change a medication without the clinician who manages it. Every numeric, regulatory, and citation claim was verified against primary journal, federal, and labeling sources on September 7, 2026. Guidelines, drug labels, and public-health data change; confirm current status before acting on anything here.

Related reading on NP FADY

• Antidepressant side effects and how clinicians manage them
• Coming Off an Antidepressant Without the Crash: Withdrawal, Relapse, and How Tapers Really Work
• When Nothing Feels Like Anything: Anhedonia, Emotional Blunting, and the Way Back

References

1. National Institute for Health and Care Excellence. Depression in adults: treatment and management (NG222). Published June 29, 2022; recommendations checked 2026. Recommendations.

2. Qaseem A, et al. “Nonpharmacologic and Pharmacologic Treatments of Adults in the Acute Phase of Major Depressive Disorder: A Living Clinical Guideline From the American College of Physicians.” Annals of Internal Medicine. 2023. DOI: 10.7326/M22-2056.

3. American Psychiatric Association. “Clinical Practice Guidelines.” Current-status page checked September 7, 2026. Guidelines page. American Psychological Association. “Clinical Practice Guideline for the Treatment of Depression Across Three Age Cohorts.” 2019; status checked 2026. Guideline page.

4. Lam RW, et al. “Canadian Network for Mood and Anxiety Treatments (CANMAT) 2023 Update on Clinical Guidelines for Management of Major Depressive Disorder in Adults.” Canadian Journal of Psychiatry. 2024;69(9):641–687. DOI: 10.1177/07067437241245384. Open full text.

5. Department of Veterans Affairs and Department of Defense. VA/DoD Clinical Practice Guideline for the Management of Major Depressive Disorder. Version 4.0, February 2022. Guideline.

6. Lewis G, et al. “Maintenance or Discontinuation of Antidepressants in Primary Care.” New England Journal of Medicine. 2021;385(14):1257–1267. DOI: 10.1056/NEJMoa2106356. PubMed.

7. Zaccoletti D, Mosconi C, Gastaldon C, et al. “Comparison of antidepressant deprescribing strategies in individuals with clinically remitted depression: a systematic review and network meta-analysis.” The Lancet Psychiatry. 2026;13(1):24–36. DOI: 10.1016/S2215-0366(25)00330-X. PMID: 41386898. Abstract.

If you or someone you know is in crisis

• Call 911 or go to your nearest emergency room for any life-threatening emergency.
• 988 Suicide & Crisis Lifeline — call or text 988, available 24/7. En español: marque 988 y oprima 2. Veterans: 988 and press 1, or text 838255.
• Crisis Text Line — text HOME to 741741.
• The Trevor Project (crisis support for LGBTQ+ young people) — call 1-866-488-7386, or text START to 678-678.
• National Sexual Assault Hotline (RAINN) — call 1-800-656-HOPE (4673) or text HOPE to 64673; free, confidential, 24/7. Online chat at RAINN.org/hotline.
• National Domestic Violence Hotline — call 1-800-799-SAFE (7233) or text START to 88788; 24/7, help in 200+ languages. Online chat at TheHotline.org. If your phone or computer may be monitored, calling from a safer device is an option.
• Riverside County — Inland SoCal Crisis Helpline 951-686-HELP (4357), 24/7 (Inland SoCal United Way / 211+, in partnership with RUHS-BH); Community Access, Referral, Evaluation and Support (CARES) Line 800-499-3008, 24/7.
• San Bernardino County — Access Unit (Behavioral Health Helpline) 888-743-1478, 24/7; Mobile Crisis/CCRT 800-398-0018 (24/7, all ages) or text 909-420-0560. Arrowhead Regional Medical Center (ARMC) has a dedicated walk-in adolescent psychiatric ER (ages 13–17).
• Children under 13 — call 911 for immediate danger, contact your county's mobile crisis team (they respond to all ages), or go to the nearest pediatric emergency room.
• California Peer-Run Warm Line (non-crisis — someone to talk to) — call or text 1-855-600-WARM (9276); daytime and evening hours, not a 24/7 line.
• NP Fady (non-emergency) — for routine scheduling or questions, call (909) 707-6261. This line is not monitored for emergencies.