A study of UK patients with a long history of depression shows how difficult it can be to stop drugs, even for those who feel well enough to try.
Just over half of the participants who gradually stopped their antidepressants relapsed within a year. In contrast, the relapse rate was lower – nearly 40% – for those who continued to take their usual medications during the study.
Both groups were taking daily doses of common antidepressants, had recovered from their last episode of depression, and felt healthy enough to consider stopping the drugs.
Previous research has also shown that relapses are common, and an editorial published Wednesday with the study in the New England Journal of Medicine suggests lifelong medication may be advised for some patients who have already had multiple episodes.
Counseling and behavioral therapy are other options for patients who want to quit antidepressants, and studies show that these treatments combined with drugs work well for many.
Few of the UK patients in the government-funded study received any psychological treatment. Although the UK’s national healthcare system offers it, it’s difficult to access due to long wait times for treatment, said Gemma Lewis, lead author of the study and researcher at University College. London. Patients in the study were being treated for depression by primary care doctors, which is common in the UK, Lewis said.
Depression is a mood disorder that can include lingering and debilitating feelings of sadness, hopelessness, and loss of interest in usual activities. It affects about 5% of adults worldwide, according to the World Health Organization. Reported rates are slightly lower in the UK and higher in the US, but Lewis said the different ways of assessing depression make comparisons between countries difficult.
The study recruited 478 patients from four cities in England, mostly middle-aged white women. All were taking a common class of antidepressants called selective serotonin reuptake inhibitors, which include drugs known by the brand names Prozac and Zoloft. Half were randomly assigned to gradually stop medication, the rest made no medication changes. It is not known if similar results would be found in other patients taking other antidepressants.
While 56% of the patients who stopped their treatment relapsed during the study, Lewis pointed out that a significant portion did not, including most who remained on their antidepressants.
“There are a lot of people out there who would like to stay on their antidepressants and the document shows that for a lot of people this is an appropriate decision,” Lewis said.
Editorial author Dr Jeffrey Jackson of the Milwaukee Veterans Medical Center called the study’s results important but disappointing. But he also suggested that stopping antidepressants is possible for some patients.
“I encourage patients with a single episode of depression, especially episodes triggered by a life event, such as the loss of a loved one, to consider weaning off antidepressant treatment after at least 6 months of remission. Jackson wrote in the op-ed.