Dr. Miller
Clinical question: For patients on longstanding antidepressant therapy who feel well enough to discontinue antidepressants, what is the risk of relapse with maintaining or discontinuing antidepressants?
Background: Patients with depression may receive antidepressants for prolonged periods. Data are limited on the effects of maintaining or discontinuing antidepressant therapy in this setting.
Study design: Randomized, double-blind trial enrolling patients who had been taking antidepressants for two years or longer and felt well enough to consider stopping antidepressants.
Setting: At 150 general outpatient practices in the U.K. enrolling 1,466 patients.
Synopsis: The primary outcome of relapse of depression by 52 weeks occurred in significantly more patients in the discontinuation group compared to the maintenance group. (56% versus 39% respectively; HR 2.06, P<0.001).
Bottom line: Among ambulatory patients who felt well enough to discontinue antidepressant therapy, those who were assigned to stop their medication had a higher rate of relapse by 52 weeks. These findings may inform clinical decisions by hospitalists about discontinuing pre-existing antidepressant therapy.
Citation: Lewis G et al. Maintenance or discontinuation of antidepressants in primary care. N Engl J Med. 2021 Sep 30;385(14):1257-1267. doi: 10.1056/NEJMoa2106356.
Dr. Miller is an assistant professor of medicine at the University of Colorado School of Medicine hospital medicine section, Rocky Mountain Regional VA Medical Center, Aurora, Colo.
It’s interesting that maintenance patients still relapse at a rate of 39%. It maybe worth hazarding relapse an extra 17% chance of relapse to lower polypharmacy, cost and caretaker burden.