Stopping antidepressants or not?

Abstract

Background Recently, there has been media and public interest regarding discontinuation of antidepressant treatment, especially in primary care. In this context, we provide a primary care update on the maintenance or discontinuation of antidepressant medication for the treatment of moderate-to-severe depression in adults.

Objective This article aims to provide a primary care update on the maintenance or discontinuation of antidepressant medication for the treatment of moderate-to-severe depression in adults. To this end, we performed a qualitative narrative review and provide commentary on recent research and systematic reviews.

Discussion In primary care, recent research has shown that there are substantial risks of depressive relapse resulting from antidepressant discontinuation. For a first episode of moderate-to-severe depression, antidepressants should be continued for 9–12 months after remission. Systematic reviews indicate that, overall, there is limited evidence of benefits from ceasing antidepressant treatment for recurrent depression. The existing evidence base on antidepressant withdrawal is limited in quality and extent, providing some evidence of harms, such as relapse, and not necessarily any gains, although reducing the burden of adverse effects is a consideration. There is a benefit-to-risk ratio in any decision to continue or withdraw antidepressant treatment.