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 Researchers analyzed the combined results from 28 previously
published studies with a total of 5,233 participants who had been on
antidepressants for up to one year. Patients were randomly assigned
to either continue medication or switch to placebo, or dummy, pills.
Over the next year, patients who discontinued treatment were roughly
three times more likely to relapse than people who remained on
antidepressants, researchers report in The BMJ.
“Patients and their doctors should be aware that discontinuing
antidepressants within a year is associated with increased relapse
risk,” said lead study author Dr. Neeltje Batelaan of the VU
University Medical Center in Amsterdam.
“This should be taken into account when discussing discontinuation,”
Batelaan said by email. “It does not imply that all patients should
remain on antidepressants for the rest of their lives.”
That’s because the majority of patients who discontinue
antidepressants do not relapse, and because relapse sometimes occurs
even when patients are still taking these medications, Batelaan
added.
Overall, relapse occurred in about 36 percent of people who switched
to placebo and 16 percent of those who remained on antidepressants,
the study found.
And among the patients who did relapse, this happened more than
three times faster for people switched to placebo than for
individuals kept on antidepressants.
It’s not exactly clear why some patients relapsed, but it’s unlikely
to have been caused by withdrawal symptoms among the people who
discontinued treatment, Batelaan said.
Many antidepressants work by altering the way certain chemicals in
the brain such as serotonin, dopamine and norepinephrine transmit
signals involved in controlling emotions and moods. Stopping
antidepressants is thought to change how these brain chemicals
function, which may lead to relapse in some people.
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Side effects of antidepressants can include nausea, weight gain,
sexual dysfunction, insomnia, blurred vision and constipation. One
limitation of the study is that it included only patients who had
been taking these medications for up to a year, making it likely
that all or most of the participants didn’t need to halt treatment
due to side effects.
Another drawback of the study is its reliance primarily on published
studies funded by drug companies, which the authors note might bias
the results toward showing the benefits of continuing antidepressant
treatment.
Even so, the results add to a large body of evidence already
suggesting that patients on antidepressants may be more prone to
relapse when they discontinue treatment than when they remain on
medication, said Dr. Ronald Pies, a psychiatry researcher at SUNY
Upstate Medical University in Syracuse, New York, and Tufts
University School of Medicine in Boston.
“If the patient has a fairly severe or recurrent anxiety disorder
that has not responded to cognitive-behavioral therapy alone, the
use of an antidepressant for up to a year and possibly longer can be
justified, owing to the risk of relapse with medication - so long as
the patient is tolerating the treatment reasonably well,” Pies, who
wasn’t involved in the study, said by email.
“Not all patients will need long-term medication,” Pies added. “In
fact, the study found that most patients do well when discontinuing
treatment.”
SOURCE: http://bit.ly/2x0HP3o The BMJ, online September 13, 2017.
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