Many users of antidepressants experience a relapse within a year if they stop taking the medication, a new study reveals.
Research led by UCL, UK – the first from a large discontinuation trial of people taking antidepressants for multiple years in primary care – found 56% relapsed compared with 39% of those who stay on medication.
Writing in The New England Journal of Medicine, the research team say their findings can help doctors and patients make an informed decision as to whether or not antidepressants should be stopped after recovery from a depressive episode.
The National Institute for Health Research-funded study involved 478 primary care patients in England who had been taking long-term antidepressants – citalopram, sertraline, fluoxetine, or mirtazapine – and who felt well enough to consider stopping.
Out of the cohort, 70% had been taking the medication for more than three years.
The randomised, double-blind controlled trial, which also involved researchers from the Universities of York, Southampton and Bristol, and McMaster University in Canada, saw half of the study participants stopping their medication, while half continued.
Those who discontinued their antidepressants were given reduced dosages for up to two months as part of a tapering regime, before being given placebo pills.
Over the following year, 56% of participants who discontinued antidepressants experienced a new episode of depression, compared to 39% of participants who continued them.
Of those who experienced relapse after discontinuation, half chose to return to an antidepressant prescribed by their clinician.
Appropriate for many
Those who discontinued their antidepressants were more likely to experience withdrawal symptoms, but by the end of the study, 59% of the discontinuation group no longer took antidepressants.
Lead author Dr Gemma Lewis, from UCL Psychiatry, said: “Prescriptions of antidepressants have increased dramatically over recent decades as people are now staying on antidepressants for much longer. Until now we didn’t know whether antidepressant treatment was still effective when someone has been taking them for many years.
“We have found that remaining on antidepressants long-term does effectively reduce the risk of relapse. However, many people can stop their medication without relapsing, though at present we cannot identify who those people are.
“Our findings add to evidence that for many patients, long-term treatment is appropriate, but we also found that many people were able to effectively stop taking their medication when it was tapered over two months.”
Co-lead author Dr Louise Marston, of UCL Institute of Epidemiology & Health Care, added: “We do not yet know why some people seem able to come off their antidepressants and some cannot, so further research may help us to predict who can stop antidepressants safely.”
Lewis G, Marston L, Duffy L et al. Trial of Discontinuation vs Maintenance of Antidepressants in Primary Care. NEJM 30 September 2021; doi: 10.1056/NEJMoa2106356.
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