‘Stopping antidepressants or not?’

A new deep dive into the maintenance or discontinuation of antidepressant medication has found the risk to patients of relapse remains a key issue in primary care decision-making.
 
Published in the Australian Journal of General Practice (AJGP) this month, the analysis asks the question ‘stopping antidepressants or not?’.
 
In Australia, GPs are the primary prescribers of antidepressant medications, with the number of prescriptions on the rise.
 
According to the study, around half of patients who begin antidepressant treatment are prescribed selective serotonin reuptake inhibitors, 25% are prescribed tricyclic antidepressants, and 13% are prescribed serotonin-norepinephrine reuptake inhibitors or other agents.
 
The analysis says that while antidepressant treatment for depression in adults is effective, ‘the ongoing role of antidepressant treatment for patients successfully treated for moderate-to-severe depression needs to be reconsidered’.
 
‘A key issue is whether a patient is likely to relapse following antidepressant discontinuation,’ it says.
 
‘While acknowledging there is concern whether some withdrawal symptoms might be mistaken for relapse, the ANTLER RCT long-term follow-up study demonstrates that there is a very substantial risk of relapse after discontinuation of long-standing antidepressant treatment.’
 
The authors say that for patients in primary care, there must be a ‘clear and careful discussion’ about whether discontinuation is ‘feasible for them’, with withdrawal symptoms highlighted.
 
‘Benefits and harms of antidepressant treatment can be discussed with patients in collaborative primary care planning,’ they said.
 
The analysis says that for first episodes of depression, treatment is recommended for between nine and 12 months, and for recurrent episodes of depression treatment is for two years or indefinitely.
 
The study also highlighted emerging areas of interest regarding management of depression, including the ‘sequential depression treatment model’, in which antidepressant medication is ‘used in the acute phase and psychotherapy in the continuation phase’.
 
Study author and Acting Head of General Practice at the Australian National University Professor Katrina Anderson said the analysis highlights the complexity of these conversations.
 
‘When patients start antidepressants, they often ask us “how long will I be on them?”. It can be hard to answer this,’ she told newsGP.
 
‘Often when people start antidepressants, they are also making changes to their lives and so their treatment is so much more than an antidepressant.
 
‘Down the track when considering cessation, it is not just about the medicine but rather a conversation that explores many other factors in their life.’
 
The authors concluded by recommending further research into depression include larger scale studies into the ‘whole-person approach’.
 
This could include exploring the impacts of lifestyle modifications and preventative activities, and exploring the role of ‘psychotherapy and/or counselling to identify and manage predisposing and precipitating factors’.
 
Log in below to join the conversation.

antidepressant medication anxiety deprescribing depression