Stopping antidepressants tied to increased relapse risk

By Lisa Rapaport

(Reuters Health) – 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, or
dummy, 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.

“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 percent of people who
switched to placebo and 16 percent 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.”

SOURCE: The BMJ, online September 13, 2017.