Long-term use of antidepressants is effective, but many people can safely get rid of them, new research shows.
The number of prescriptions for antidepressants in rich countries has doubled in the last 20 years. This increase is mainly due to people who stay on antidepressants for a long time.
There are now many people who have been taking these drugs for several years and feel well enough, but are unsure if they are still benefiting from them.
Many people who have suffered from depression continue to take antidepressants for years for fear that if they stop, they could relapse.
Most studies of antidepressants and relapses have been done in people taking the drug for less than eight months. We wanted to know if the antidepressant treatment was still effective when people had been on the pill for several years.
Our study, published in the New England Journal of Medicine, found that staying on antidepressants long term reduced the risk of relapse, but many people were able to get rid of them safely.
For the research, we recruited 478 people who were on long-term antidepressant treatment, 70% of whom had been taking antidepressants for more than three years.
All of the patients had a history of at least two episodes of depression, had been taking their antidepressants for at least nine months, and felt well enough to consider stopping the pill.
All patients, from 150 general practitioner practices in England, were interviewed by a researcher, and we excluded those who had symptoms of depression that met the criteria for a clinical diagnosis.
We recruited people who were taking the most commonly prescribed antidepressants – sertraline, citalopram, and fluoxetine. These are all selective serotonin reuptake inhibitors (SSRIs) that increase serotonin levels in the brain. We have also included mirtazapine, a newer antidepressant increasingly used in the UK.
We randomly assigned people to one of two groups: half of the study participants stopped taking their antidepressants and the other half continued. The group that stopped their medication received reduced doses of their antidepressants for up to two months until they were on placebo only.
The other group continued with the same dose of antidepressant they were already receiving.
Neither the researchers nor the patients knew which group people were assigned to. This type of “double-blind study” helps reduce bias. After the start of the study, we collected data from the participants at intervals of six, 12, 26, 39, and 52 weeks after the start of the trial.
In the following year, 56% of people who stopped taking their antidepressants relapsed, compared to 39% of people who continued to take them.
Thus, staying on antidepressants is appropriate for many people receiving long-term treatment from their GP. We found no evidence that the antidepressants in our study had serious side effects.
Staying on antidepressants did not guarantee well-being in our study – 39% of people who continued to take their regular dose relapsed within one year. The decision to continue with long-term treatment is balanced by the potential side effects, and many people prefer not to take medication for many years.
No relapse in 44% of participants
In our study, many people were able to safely stop their antidepressants without a relapse. In the group that stopped their antidepressants, 44% did not relapse after a full year.
Even among those who relapsed after quitting, only half chose to resume an antidepressant prescribed by their GP.
Many patients might decide to stop their antidepressants, in consultation with their doctor, knowing that there could be a risk of relapse.
If people who want to stop their antidepressants are regularly monitored by their GP, it may be possible to prevent relapses with different treatments, such as talk therapy. For example, studies have shown that Mindfulness-based cognitive therapy is effective in preventing relapses.
There is uncertainty about the extent to which people experience withdrawal symptoms after they stop taking antidepressants.
In our study, people who stopped their antidepressants after reducing the dose over two months were more likely to experience withdrawal symptoms, such as irritability and difficulty concentrating, than those who continued treatment. Yet at the end of the study, a year later, 59% of the dropout group were not taking antidepressants.
Our study only provides information on the average likelihood of relapse.
We do not yet know why some people are able to stop their antidepressants and others are not. Further research can help us predict who can safely stop antidepressants.
Our study provides an estimate of the risk of relapse if a person continues to take antidepressants long-term or decides to stop them. These results will help doctors and patients together make an informed decision about whether or not to stop long-term antidepressant treatment.
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