American Board of Internal Medicine (ABIM) Certification Practice Exam

Patients with a history of which condition should be considered for indefinite antidepressant treatment?

1. A single depressive episode

2. Chronic episodes lasting ≥2 years

3. Recent job loss leading to depression

4. Mild depression without treatment history

The correct answer is: Chronic episodes lasting ≥2 years

Indefinite antidepressant treatment is particularly indicated for patients with chronic episodes of depression lasting two years or more, which reflects a more persistent and severe course of the disorder. Chronic depression often indicates a greater risk for future episodes, ongoing functional impairment, and may be associated with comorbid conditions that can further complicate treatment. The likelihood of recurrence is significantly higher in patients who have experienced long-standing depression, thus justifying a more aggressive and prolonged treatment approach. This strategy is rooted in evidence suggesting that individuals with chronic or recurrent depression benefit significantly from continued treatment, reducing the risk of relapse and improving overall functioning. In contrast, individuals with a single depressive episode might not necessitate indefinite treatment, as they could have a lower risk of recurrence. Recent job loss might lead to depression, but if it’s situational and not indicative of underlying chronic issues, it may not require long-term treatment. Lastly, mild depression without a treatment history may also respond adequately to short-term interventions rather than indefinite medication, especially when you consider options like therapy or lifestyle changes. Hence, the chronic nature of depression lasting two or more years emphasizes the need for ongoing treatment, making it the most appropriate consideration for indefinite antidepressant treatment.