High Rate of Antidepressant Discontinuation in Primary Care Settings Leads to Depression Relapse

Individuals being treated for depression who feel well enough to discontinue medication therapy may be at risk for later depression relapse, according to the results a recent randomized, double-blind trial.

To better understand the impact of discontinuing antidepressant use in individuals who have prolonged use of antidepressants, the researchers randomly assigned 478 total participants into 2 groups: one group maintained current therapy (n = 238) and one group discontinued current therapy (n = 240) through the use of a placebo.

Included were adults with depression who were taking citalopram, fluoxetine, sertraline, or mirtazapine in 1 of 150 primary care practices throughout the United Kingdom. To be included, all patients must have had a history of at least 2 depressive episodes or had been taking antidepressants for 2 years or longer.

The results indicated that by the end of the 52-week trial period, relapse occurred in 39% (n = 92) of the maintenance group and 56% (n = 135) of the discontinuation group.

Further, 70% of the maintenance group adhered to the trial assignment, whereas 52% of the discontinuation group adhered to the trial assignment. When compared with the maintenance group, the discontinuation group reported more symptoms of depression, anxiety, and withdrawal.

“Among patients in primary care practices who felt well enough to discontinue antidepressant therapy, those who were assigned to stop their medication had a higher risk of relapse of depression by 52 weeks than those who were assigned to maintain their current therapy,” the researchers concluded.

—Leigh Precopio

Reference:

Lewis G, Marston L, Duffy L, et al. Maintenance or discontinuation of antidepressants in primary care. N England J Med. 2021;385(14):1257-1267. doi:10.1056/NEJMoa2106356