Maintenance antidepressant medication is the most commonly used preventive strategy for depression, a highly recurrent disease. However, little is actually known about the discontinuation of maintenance antidepressant use and the association with recurrence in daily clinical practice.
The shed some light on this Claudi L.H. Bockting and colleagues examined the discontinuation rate of maintenance antidepressant in daily clinical practice in recurrently depressed patients and the associated risk of recurrence.
Prospectively antidepressant maintenance medication and recurrence were examined in 172 euthymic patients with recurrent depression. Antidepressant user profiles before recurrence (nonusers, intermittent users, continuous users) were examined and related to recurrence over a 2-year follow-up period.
Less than half of the patients (42%) used antidepressants continuously. Taking into account the minimal required adequate used dosage (20 mg fluoxetine equivalent), only 26% of the patients used AD as recommended by international guidelines. Despite the continuous use of antidepressants, 60.4% of the patients relapsed within 2 years. This relapse rate was comparable to the rate of the intermittent users (63.6%). In patients who stopped taking antidepressants after remission and who received additional preventive Cognitive Therapy, the recurrence rates were significantly lower than in non-antidepressant-using patients treated with usual care (8% versus 46%).
The majority of recurrently depressed patients treated with antidepressant discontinue maintenance antidepressant therapy in daily primary and secondary clinical practice. Antidepressant seems to offer poor protection against relapse in this patient group.
Patients who stopped using antidepressants experienced less relapse, especially if they were treated with preventive Cognitive Therapy.
The study's authors believe alternative maintenance treatments - including preventive Cognitive Therapy after discontinuation of antidepressants - requires further studies in recurrently depressed patients with intermittent good remissions, not only in secondary but also in primary care.
Bockting CL, ten Doesschate MC, Spijker J, et al. Continuation and Maintenance Use of Antidepressants in Recurrent Depression. Psychother Psychosom. 2008;77(1):17-26. [Abstract]