• Posted September 29, 2021

Stopping Antidepressants Raises Relapse Risk

People who stop taking antidepressants after long-time use may face a high likelihood of spiraling into depression again, a new study suggests.

British researchers found that among patients who stopped taking their antidepressants because they felt well, 56% relapsed within a year. That compared with 39% of patients who stayed on medication.

Experts said the results offer some hard data to help answer a common question.

"Often, patients want to know: How long do I need to be on this medication?" said Dr. Christine Crawford, associate medical director of the National Alliance on Mental Illness.

"This study helps equip psychiatrists in talking to patients about the risk of relapse if they stop taking their antidepressant," said Crawford, who was not involved in the trial.

Studies, of course, look at averages across groups. So the findings do not give a black-and-white answer to any one patient.

Crawford said people who are receiving psychological counseling and have strong relationships with family and friends are likely to do better after stopping antidepressants than people who lack those support systems.

"With those patients, I'd be more comfortable discontinuing medication if they want to," Crawford said.

In addition, the study focused on patients with a fairly long history of depression: They'd had multiple episodes over time, and most had been taking antidepressants for more than three years.

So the findings do not necessarily apply to people being treated for a first-time episode, said lead researcher Gemma Lewis, of University College London.

Like Crawford, Lewis said the findings give doctors and patients data to help make an "informed decision" about stopping antidepressants.

"Our findings add to evidence that for many patients, long-term treatment is appropriate, but we also found that many people were able to effectively stop taking their medication when it was tapered over two months," Lewis said.

Overall, 44% of patients who stopped their medication did not suffer a relapse in the next year. So some patients, Lewis said, might still decide to discontinue, knowing the odds.

The findings are based on 478 primary care patients who had been on long-term antidepressants. All had recovered from their most recent depressive episode and felt well enough to try coming off medication.

Half were randomly assigned to gradually taper off their medication over two months; the other half stuck with their prescription.

Over the next year, 56% of patients who had stopped medication had a depression relapse, compared to 39% of those who had stayed on medication. Those who discontinued medication also gave lower ratings to their quality of life, on average.

Crawford stressed that the findings don't mean that people had become "addicted" to antidepressants. For many patients, she said, the medications are simply an effective way to treat a chronic medical condition -- just as people take medications for high blood pressure or diabetes.

"I think it's helpful for patients who are feeling well to see there are benefits from staying on antidepressants," Crawford said, "so they don't think they're taking a medication for no reason."

Still, the trial suggests that relapses were not necessarily severe, the researchers said. Of patients who relapsed, only half decided to go back on their old medication.

Nor is staying on an antidepressant a guarantee of lasting well-being -- as more than one-third of those study patients suffered a relapse anyway.

According to Lewis, only a small percentage of patients were receiving psychological therapy when the trial began.

Past research, she said, has shown that people generally fare better with a combination of medication and talk therapy, compared to either alone. There is also evidence that psychological counseling can curb the odds of relapse after stopping antidepressants, Lewis added.

"Medication is just one piece of the puzzle," Crawford said. "They're not magic pills."

But, she added, antidepressants may help "lighten the load" of depression, making it easier for people to manage the stresses in their lives.

The findings appear in the Sept. 30 issue of the New England Journal of Medicine.

More information

The National Alliance on Mental Illness has more on treating depression.

SOURCES: Gemma Lewis, PhD, lecturer and senior research fellow, Division of Psychiatry, University College London, England; Christine Crawford, MD, MPH, associate medical director, National Alliance on Mental Illness, Arlington, Va.; New England Journal of Medicine, Sept. 30, 2021