A patient has been taking paroxetine (Paxil)for major depressive symptoms for 8 months.The patient tells the primary care NP that these symptoms improved after 2 months of therapy.The patient is experiencing weight gain and sexual dysfunction and wants to know if the medication can be discontinued.The NP should:

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Once a patient achieves remission,a continuation phase of 16 to 20 weeks followed by a maintenance phase of 4 to 9 months should be carried out.Some responders,called apathetic responders,may have a decrease in most symptoms but continue to have lack of pleasure,decreased libido,and lack of energy.Bupropion can be added to therapy to treat these symptoms.Patients should not change medications during this phase,should not begin a drug taper,and should never stop the medication abruptly.

A Patient Has Been Taking Paroxetine (Paxil)for Major Depressive Symptoms