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.