People who stop taking antidepressants because they feel they no longer need them could trigger a relapse into depression, a study has shown. The findings may be taken by some as reason to continue taking such medicines indefinitely – but in fact the picture is more complex.
In many high-income countries, the number of people taking antidepressants are at record levels, with an estimated one in 10 people using antidepressants in England. The medicines can cause side effects such as loss of sex drive and sleeping problems, and can be hard to stop taking.
Some say that doctors are too willing to prescribe these drugs to people who might be better helped by psychological therapies or by changing their life circumstances, but people who feel they benefit from the medicines sometimes see such sentiments as “pill shaming”. The question has become mired in ideological debates over .
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There is also confusion over how the drugs work. Most antidepressants are a class of drug called selective serotonin reuptake inhibitors (SSRIs). For a long time, it was thought that people experiencing depression have low levels of the brain signalling chemical serotonin, which SSRIs restore. If that were so, it would make sense that some people would need antidepressants for life. But it now seems that this “chemical imbalance” theory of depression is wrong – and we still don’t know the real biological explanation for depression, or how SSRIs alleviate it in some cases.
The latest study doesn’t answer that question, but it should provide some insights for people who are weighing their options when it comes to these medicines. It looked at 478 people in the UK on an antidepressant who were considering stopping taking the pills. About half were chosen at random to continue, while the rest were given placebo tablets instead of their usual pills.
After one year, 56 per cent of people given a placebo saw their depression return, compared with 39 per cent who continued taking the medicine. Put another way, for every 10 people weighing up the decision of whether to stop taking antidepressants, about four would relapse, and just over four would stay depression-free, whatever course they decided to take. For the others, stopping the medicines may lead to a relapse. “Although the risk of relapse is increased [by stopping], it’s not increased hugely over continuing to take antidepressants,” says at the University of Southampton, UK, one of the researchers.
The findings suggest that either decision is reasonable, and the choice people make depends on their personal preferences, he says. For some, the risk of experiencing depression again would be too great, while others may have a stronger preference not to be on long-term medication.
Kendrick stresses that anyone wishing to stop taking antidepressants should do so under their doctor’s guidance. People who stop taking the drugs suddenly can experience temporary withdrawal symptoms including low mood and agitation, which can be confused with a relapse.
The problem of withdrawal symptoms keeping people stuck on antidepressants has recently become more recognised. Medical bodies used to advise that people could taper off these medicines by just taking half their normal dose for two weeks. The UK’s Royal College of Psychiatrists now says the tapering period can take months or longer, especially if someone has been on the medicines for years. People in this new study were generally weaned off by being given a half dose for the first month and a quarter dose during the second month.
Whatever people’s decision, it is good news that from now on, it can be more informed by evidence, rather than ideology.
The New England Journal of Medicine
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