The variety of prescriptions written for antidepressants in rich nations has doubled prior to now 20 years. This improve is usually as a consequence of individuals staying on antidepressants for a very long time. There at the moment are many individuals who’ve been on these medicine for a number of years and really feel pretty nicely, however are not sure whether or not they nonetheless profit from taking them.
Many individuals who’ve had melancholy proceed to take antidepressants for years for worry that in the event that they cease, they may have a relapse. Most research of antidepressants and relapse have been completed in individuals taking the treatment for lower than eight months. We wished to know whether or not antidepressant remedy was nonetheless efficient when individuals have been taking the tablets for a number of years.
Our examine, printed within the New England Journal of Drugs, discovered that remaining on antidepressants long-term decreased the chance of a relapse, however many individuals had been capable of come off them safely.
Our examine recruited 478 individuals who had been receiving long-term antidepressant remedy, 70% of whom had been taking antidepressants for greater than three years. All of the sufferers had a historical past of at the very least two episodes of melancholy, had been taking their antidepressants for at least 9 months, and felt nicely sufficient to contemplate stopping the tablets.
All sufferers, from 150 GP surgical procedures in England, had been interviewed by a researcher, and we excluded those that had signs of melancholy that met the standards for a medical analysis. We recruited individuals who had been taking probably the most generally prescribed antidepressants – sertraline, citalopram and fluoxetine. These are all selective serotonin reuptake inhibitors (SSRIs) that improve serotonin ranges within the mind. We additionally included mirtazapine, a more moderen antidepressant that has been rising in use within the UK.
We randomly allotted individuals to considered one of two teams: half of the examine members stopped taking their antidepressant treatment and half continued. The group who stopped their treatment got decreased doses of their antidepressants for as much as two months till they had been on placebo solely. The opposite group continued with the identical dose of the antidepressant they had been already receiving.
Neither researchers nor sufferers knew which group individuals had been allotted to. One of these “double-blind examine” helps to scale back bias. After the examine began, we collected information from members at intervals of six, 12, 26, 39 and 52 weeks after they began the trial.
Over the next yr, 56% of people that stopped taking their antidepressants skilled a relapse, in contrast with 39% of people that stored taking them. So, remaining on antidepressants is suitable for many individuals receiving long-term remedy from their GP. We didn’t discover any proof that the antidepressants in our examine had severe side-effects.
Remaining on antidepressants didn’t assure wellbeing in our examine – 39% of people that continued with their common dose had a relapse inside a yr. The choice to stay on long-term remedy is offset by any potential side-effects and many individuals desire to not take treatment for a few years.
No relapse in 44% of members
In our examine, many individuals had been capable of come off their antidepressants safely with out a relapse. Within the group who stopped their antidepressants, 44% didn’t relapse after a full yr. Even amongst those that did relapse after stopping, solely half selected to return to an antidepressant prescribed by their GP.
Many sufferers would possibly determine to cease their antidepressants, in session with their physician, realizing there is perhaps a threat of relapse. If individuals who wish to discontinue their antidepressants are frequently monitored by their GP, it could be doable to stop relapses with completely different therapies, akin to speak remedy. For instance, research have proven that mindfulness based mostly cognitive remedy is efficient at stopping relapse.
There was uncertainty concerning the extent to which individuals expertise withdrawal signs after they cease taking antidepressants. In our examine, individuals who stopped their antidepressants after decreasing the dose over two months had been extra more likely to expertise withdrawal signs, akin to irritability and problem in concentrating, than those that continued remedy. But, by the top of the examine, a yr later, 59% of the discontinuation group weren’t taking antidepressants.
Our examine solely offers details about the typical chance of relapse. We don’t but know why some individuals are capable of come off their antidepressants and a few can not. Additional analysis might assist us to foretell who can cease antidepressants safely.
Our examine offers an estimate of the chance of relapse if somebody carries on with long-term antidepressants or decides to cease them. These findings will assist docs and sufferers to make an knowledgeable choice collectively on whether or not or to not cease long-term antidepressant remedy.
Glyn Lewis receives funding from NIHR. He has acquired revenue from Fortitude Legislation in relation to litigation regarding antidepressants.
Gemma Lewis doesn’t work for, seek the advice of, personal shares in or obtain funding from any firm or organisation that will profit from this text, and has disclosed no related affiliations past their tutorial appointment.