Among patients who had experienced at least two previous episodes of depression or who had been taking antidepressants for more than 2 years, those who remained on their medication had a significantly lower rate of relapse within a year than those who stopped treatment, a UK trial has found.
The trial enrolled adults from 150 general practices who had been taking citalopram, fluoxetine, sertraline or mirtazapine for at least 9 months, and felt well enough to discontinue treatment. Approximately three quarters of the patients were women, with a mean age of 54 years; approximately 95% were white.
Participants were randomly assigned to maintain their current antidepressant therapy, or to taper and discontinue such therapy with the use of matching placebo.
By 52 weeks, relapse occurred in 92 of 238 patients (39%) who were continuing to receive antidepressants compared with 135 of 240 patients (56%) of patients who discontinued treatment.
Withdrawal symptoms at 12 weeks were more common in the group that discontinued treatment than among the group that continued to receive their typical regimen, but serious adverse events occurred at similar rates in the two groups (4% and 3%, respectively). There were no deaths or suicide attempts during the trial.
Professor Guy Goodwin, emeritus professor of psychiatry at the University of Oxford, said: 'This is an encouraging study that largely supports how GPs treat patients in the UK with recurrent depression. Thus continuing treatment with SSRIs has a sustained advantage over placebo, which supports the view that antidepressants can work for many people. What is just as important is that patients who wish to discontinue SSRIs can do so without major problems from withdrawal effects.
Professor Sir Simon Wessely, Regius chair of psychiatry at King’s College London, said: 'This is a very important study. It mirrors one of the first randomised controlled trials ever undertaken in depression, which found some benefit to staying on antidepressants for at least six months after you had recovered from a depressive illness. Now we know this applies for an even longer period.
'On the other hand, the other good news is that if you do want to come off antidepressants for whatever reason, this can also be done safely over a couple of months. So now patients taking long term antidepressants can make an even more informed choice than before. Yes you can come off medication, provided it’s done slowly, but there is an small but not insignificant risk of another illness.
'As ever there is no right answer, but this study provides more information to assist people in making up their minds.'