Stopping Antidepressants Tied to Increased Relapse Risk
By Lisa Rapaport
People taking antidepressants for anxiety, obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) are more likely to relapse when they stop using these drugs than when they remain on medication, a research review confirms.
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 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, online September 13.
“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% of people who switched to placebo and 16% 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.
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.”
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