Information provided in the “Ask the Doctors” column is not meant to take the place of individual consultation with a qualified health care provider. See your health care provider to discuss specific questions about your health, medication and treatment plan.

Question: Will I be able to reduce or stop my medication as my symptoms become more manageable? If so, how would I do this?

Robert N. Golden, M.D.: The answer to this question depends on your mood disorder and its severity. People with bipolar disorder need to stay on medication indefinitely in order to reduce their risk of relapse. I explain to my patients that this illness is similar to other medical conditions, such as high blood pressure or diabetes, in that ongoing treatment is very important to prevent worsening of the illness. Sometimes, under special circumstances, people with bipolar disorder may carefully taper and then discontinue their medication for limited periods of time, under their doctor’s supervision (for example, if a woman would like to get pregnant and wants to avoid the potential damaging effects of certain medications on the developing fetus, especially in the early phase of the pregnancy). But the risks involved have to be carefully considered on an individual basis, taking your entire mental health history into account.

For major depressive disorder, it is useful to think in terms of three treatment phases. The “acute phase” is the period of time from the start of treatment until a person’s symptoms improve or go away. This typically lasts from four to 12 weeks. The next phase, “continuation therapy”, usually lasts from four to nine months, starting when a person has achieved a maximum response to treatment. The third phase is “maintenance therapy”, and this can last anywhere from a year to indefinitely. All people with major depression should complete the acute and continuation phases of treatment. Maintenance therapy is strongly recommended for people who have had three or more episodes of major depression, or two episodes that were very severe, or episodes that re-occurred shortly after stopping medication. People who have had depression that was very sudden in onset, occurred early in life or was life-threatening are also recommended to have maintenance therapy. Medication dosage for maintenance therapy is generally the same as the dosage that helped the person get well. Many people find that side effects become less over time as their bodies become used to the medication.

If a decision is made to discontinue medication, it is usually best to gradually decrease the dose. Stopping medications suddenly and completely may lead to unpleasant side effects. As with any potential change in medication, decisions should be carefully considered with your doctor, who should carefully monitor the process.