[Drug discontinuation in depression]

Before stopping or starting medications in depression, the first step is a through assessment of the patient's mood disorder: past medical general and psychiatric history, psychological profile, past specific treatment history... Today some data are well demonstrated: antidepressant or lithium or carbamazepine discontinuation should be done gradually (over weeks or months) and with an intensive medical follow-up; after the acute treatment of the index depressive episode, a full therapeutic dose of the antidepressant agent should be continued for at least 4 to 6 months; antipsychotic drugs and minor tranquilizers use should be limited: combination of a neuroleptic and an antidepressant in depression with psychotic features, combination of a minor tranquilizer in depression with anxiety during the first three weeks if necessary. A contario the timing and the method of discontinuing maintenance treatment (lithium or antidepressant) have not been well studied. Literature data are discussed: frequency of recurrence during treatment discontinuation, even after long-term euthymia; possible risk for developing rapid-cycles or non response after lithium discontinuation. More precise clinical guidelines are necessary.