Health & Fitness

Mental health: To stop or stay on antidepressants

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Summary

  • Doctors usually recommend various treatment approaches that include both medication and psychotherapy.
  • As the treatment progresses and people begin feeling better, many usually wonder if it is okay for them to stop taking the medication without the risk of relapsing.
  • New research indicates that many patients taking antidepressants long-term have absolutely no idea what they would be like without drugs.

Mental health challenges are on the rise and afflicting more people in the country. Some of the common conditions include anxiety and depression.

To address these challenges, doctors usually recommend various treatment approaches that include both medication and psychotherapy (counselling) or the latter alone.

As the treatment progresses and people begin feeling better, many usually wonder if it is okay for them to stop taking the medication without the risk of relapsing.

Knowing is especially important for people who suffer from unwanted side effects of the medication they take, as well as those who simply want to be free of the financial burden associated with some of the medication.

A new study published in The New England Journal provides some insights into this matter, which can enable doctors or patients decide on the option to choose.

The study indicates that staying on medication plays a key role in preventing relapse. Nevertheless, discontinuing it also appears to hold benefits for some individuals who seem to fare well mentally, long after they stop taking the drugs.

“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,” stated Dr Gemma Lewis, the lead author of the study from the psychiatry department of the University College London (UCL).

According to the researchers, the study is the first publication from a large discontinuation trial of people taking antidepressants for multiple years in primary care.

It was funded by the United Kingdom’s National Institute for Health Research but was conducted by researchers from the UCL, the universities of York, Southampton and Bristol in the UK, as well as McMaster University based in Canada.

For the study, the researchers selected 478 primary care patients in England who had been taking long-term antidepressants (citalopram, sertraline, fluoxetine or mirtazapine). These individuals felt well enough to consider stopping the drugs.

Of the total study participants, 70 percent had been taking the medication for more than three years. During the research trial, half of them stopped taking their medication while the others continued to do so.

Those who discontinued their antidepressants were given reduced dosages for up to two months as part of a tapering regime.

At the end of the study, the researchers found that just 56 percent of participants in the first group who discontinued antidepressants experienced a relapse (a new episode of depression). The remaining 44 percent faired well.

Of the 56 percent who experienced relapse after discontinuation, only half then chose to return to an antidepressant prescribed by their clinician.

“Some relapses as well as possible withdrawal symptoms, might not have been severe enough for the person to decide they needed to return to their medication,” noted the researchers.

In the second group where individuals never stopped taking the antidepressants, only 39 percent suffered from a relapse.

Despite the higher rates of relapse in the former group compared to the latter, the researchers note that the 44 percent that fared well without the medication in the first group show that the choice to discontinue the drugs can work well in some people.

“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,” said Dr Gemma Lewis, the lead author of the study from the

Psychiatry department of the UCL

He noted: “As 44 percent of those who discontinued their antidepressants did not relapse after a full year, our findings suggest that some patients might decide to stop their antidepressant, knowing the risk of relapse, but we recommend discussing this with your doctor.”

Prof Glyn Lewis, a senior author of the study from the same institution noted that antidepressants are effective but like many medications, are not ideal for everyone.

“In our study, 39 percent of people who continued on the medication still experienced a relapse, although stopping antidepressants increased the risk of relapse further. There are also other ways to prevent relapse that might help including cognitive behavioural and mindfulness-based therapies.”

The new research indicated that many patients taking antidepressants long-term have absolutely no idea what they would be like without drugs.

“Some will not want to find out, but others will. These results show that staying on antidepressants does reduce the risk of relapse, but it does not guarantee well-being, and some people can stop antidepressants without a relapse,” stated Paul Lanham, a mental health expert who was also part of the research team.

“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,” said Dr Louise Marston, also a lead-author of the study from the UCL Institute of Epidemiology and Health Care.

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