The big question

When someone starts treatment for depression, bipolar disorder, or schizophrenia, one of the first concerns is: “How long do I have to take this?” Some people fear they’ll be on medication forever. Others stop too early and relapse. The truth lies in between: duration depends on diagnosis, risk of recurrence, and individual response.

Depression

• First episode: Antidepressants are typically continued for 6–12 months after full recovery to reduce relapse risk.

• Recurrent depression: Each recurrence raises the chance of another. After 2–3 episodes, longer-term treatment (several years) is often recommended.

• Maintenance: Some with chronic or highly recurrent depression may benefit from indefinite therapy, but this is individualized.

Bipolar disorder

• Mood stabilizers (like lithium, valproate, or lamotrigine) are the backbone of long-term management.

• Because relapse rates are high — and episodes can be severe — most patients are advised to stay on treatment long-term, often lifelong.

• Stopping medication carries significant risk of mania, depression, or mixed episodes returning.

Schizophrenia and psychotic disorders

• Relapse after stopping antipsychotics is common: up to 80% within 1–2 years of discontinuation in first-episode psychosis.

• Guidelines recommend maintenance treatment for at least 1–2 years after remission from a first episode.

• After multiple episodes, most patients require long-term or lifelong treatment, though dose reduction or long-acting injectables can help balance efficacy and side effects.

Anxiety disorders

• Antidepressants and other agents may be continued for 6–12 months after response, then tapered.

• Long-term therapy is considered if symptoms return after stopping.

Factors influencing duration

• Number of episodes: More recurrences → stronger case for longer treatment.

• Severity: Psychotic features, suicidality, or rapid cycling warrant more caution with discontinuation.

• Functional impact: If relapses severely disrupt life, long-term prophylaxis may be worth the trade-offs.

• Side effects and patient preference: Treatment decisions should always balance benefit, harm, and quality of life.

The deprescribing connection

Just as deprescribing is essential in geriatrics, it also applies in psychiatry. Not all treatment is lifelong. Medications should be reviewed regularly to assess:

• Is the benefit still clear?

• Are side effects manageable?

• Does the patient want to continue?

• Could a structured taper with monitoring be attempted?

The Maudsley guidelines emphasize gradual tapering, especially for antidepressants and antipsychotics, to avoid withdrawal and misinterpreting withdrawal as relapse.

Take-home message

• Depression: often time-limited, but longer if recurrent.

• Bipolar disorder: usually long-term or lifelong.

• Schizophrenia: long-term in most, but some may reduce under supervision.

• Anxiety disorders: months to years, depending on relapse risk.

The key is individualization. Treatment length is not a fixed sentence but a flexible plan, revisited over time.