Thursday, September 30, 2021

Stopping Antidepressants Doubles Relapse Risk, Study Finds

Patients with depression treated in primary care practices in the United Kingdom who felt well enough to consider stopping their antidepressants were twice as likely to relapse within 52 weeks if they discontinued their medication as those who continued to take it, according to a study published today in The New England Journal of Medicine.

The study, led by Gemma Lewis, Ph.D., of University College London and colleagues, involved 478 patients aged 18 to 74 years who had at least two prior episodes of depression or had been taking antidepressants for more than two years. “All the patients had been receiving and adhering to a daily regimen of 20 mg of citalopram, 100 mg of sertraline, 20 mg of fluoxetine, or 30 mg of mirtazapine for at least 9 months, had recovered from their most recent depressive episode, and felt well enough to consider stopping antidepressants,” Lewis and colleagues wrote.

The participants were randomly assigned to continue their current antidepressant therapy (maintenance group) or taper off their therapy over two months (discontinuation group). They did not know what group they had been assigned to until the end of the study. The study participants completed a battery of questionnaires at follow-ups (by mail at six weeks and face-to-face interviews at 12, 26, 39, and 52 weeks) that assessed mood, depressive symptoms, anxiety symptoms, physical side effects, withdrawal symptoms, and quality of life.

At 52 weeks, relapse had occurred in 39% of the participants in the maintenance group and 56% of the participants in the discontinuation group. Furthermore, 48% of the patients in the discontinuation group stopped taking the placebo during the trial and 39% of them returned to the use of an antidepressant.

Patients who discontinued antidepressants were nearly three times more likely than the maintenance group to report feeling worse at 12 weeks than they had at 6 weeks. Quality-of-life measures and symptoms of depression, anxiety, and medication withdrawal were generally worse in patients who discontinued their antidepressant therapy.

“These findings represent important but disappointing news. However, there are limitations to the application of the trial results to practice,” wrote Jeffrey L. Jackson, M.D., M.P.H., of the Zablocki VA Medical Center and the Medical College of Wisconsin in an accompanying editorial. For instance, it is unclear whether the trial results are generalizable to primary care patients with a first episode of depression, and it is unclear how long participants had been in remission prior to taking part in the trial, he noted.

“How do these results affect practice?” Jackson continued. “They confirm what most primary care physicians already knew or intuited. The frequency of relapse after the discontinuation of treatment is high, particularly among patients with several previous depressive episodes. … It is useful to educate patients to monitor their depressive symptoms and alert their provider if they sense they are having a relapse.”

For related information, see the Psychiatric News article “Treating Family Members Can Break Depression Cycle, Says Expert.”

(Image: iStock/SDI Productions)

How Can You Help Latina/o Patients During and After Pandemic?

In celebration of National Heritage Hispanic Month, APA’s Division of Diversity and Health Equity is sponsoring a fireside chat on “The Impact of the COVID-19 Pandemic on the Mental Health of Latinas/os” on Monday, October 4, from 4 p.m. to 5 p.m. ET. Panelists will examine strategies to improve the mental health of Latinas/os during and after the pandemic and will raise awareness of pandemic stressors such as unemployment, insurance benefits inequities, and social isolation.


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