Recent research suggests 40% of patients successfully discontinue these medications with GP and helpline support.
Can discontinuing antidepressants really be that simple?
Many patients may not require long-term antidepression treatment, but there isn’t a clear consensus on the best and most cost-effective way of tapering these patients off their medications.
New research, published in JAMA Network Open, has found combining internet or telephone support with practitioner review reduces depressive and antidepressant withdrawal symptoms while improving mental wellbeing, despite not improving discontinuation rates.
Dr Cathy Andronis, a Melbourne-based GP psychotherapist, told The Medical Republic that she hoped the findings would start a broader conversation about antidepressant discontinuation, calling the set-and-forget approach costly and harmful.
“For most people, antidepressants are indicated for short-term use – usually up to a year – to manage anxiety and depression symptoms most commonly associated with life events and adjustment disorders, particularly grief or loss, injuries, work stress and relationship problems.
“For stable and low-risk patients, most of these issues resolve naturally with time and psychosocial supports, [meaning] the pharmacological effects and emotional regulation resulting from SSRIs are not necessarily required long term.”
As part of the cluster randomised clinical trial, researchers recruited 325 adults from 131 UK practices who had been taking antidepressants for at least 12 months, were well enough to consider discontinuation (and wished to do so) and were deemed to be at low risk of relapse.
Participants in the intervention arm received an active review of their antidepressants with their GP or a nurse practitioner and were given access to an online intervention and three phone calls with a psychological wellbeing practitioner – both of which aimed to increase confidence in safely tapering and discontinuing their medication. Participants in the control arm only received the active review.
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After six months, the primary outcome of depression as measured by the Patient Health Questionnaire-9 was lower in patients receiving the intervention compared to those in the control arm (mean PHQ-9 score 4.0 versus 5.0).
A similar proportion of patients discontinued antidepressants (for at least two months) between the intervention and control arms after six (46% versus 41%) and 12 months (44% versus 38%).
“[The results show] telehealth services are effective for managing antidepressant usage and this makes a case for longer telephone MBS items to facilitate change in patients who may be reluctant or unable to attend the practice,” said Dr Andronis.
“Patients who receive limited psychosocial support do not benefit greatly in terms of discontinuation. Access to quality and longer-term psychosocial supports is critical to improving outcomes and helping patients develop resilience and wellbeing in conjunction with antidepressants.”
Patients in the intervention group reported better antidepressant withdrawal symptoms scores and mental wellbeing scores at six and 12 months, respectively; but there were no differences between them and controls in anxiety symptoms, quality of life, antidepressant adverse effects and healthcare service usage or costs.
There were also no differences in adverse events, serious or otherwise, between the two arms of the trial.
The trial was limited by a small sample size and low participation rate (only 8% of invited patients wanted to participate, only 5% were enrolled in the trial and only 73% were followed up at 12 months), by the majority of participants being of above-average socioeconomic standing and by only 2% of participants identifying as a racial or ethnic minority.
