Maintenance or discontinuation of antidepressants in primary care

Major depressive disorder is one of the most common health conditions in the world
and is characterized by persistent feelings of hopelessness, dejection, worry, poor
concentration, lack of energy, inability to sleep, and potentially suicide. In the United States,
about 19% of adults over the age of are taking an antidepressant medication.
In a multi-clinic, double-blinded, placebo controlled randomized control trial the
investigators sought to investigate relapse of depression during 52-weeks in patients who were
randomized to either maintain their antidepressant therapy (maintence group) or to decrease
and eventually discontinue their therapy. The study included patients who were between 18
and 74 years old with at least 2 prior depressive episodes or taking antidepressants for greater
than 2 years. The medications of interest at specific doses were citalopram, sertraline,
fluoxetine, and mirtazapine. At 52-weeks, depression relapse occurred in 39% of those on
maintenance therapy vs. 56% on discontinuation (HR 2.06; 95% CI 1.56 to 2.70). This study
should serve as a guide for practitioners who may be eager to discontinue antidepressants due
to the risk of depression relapse.
Follow this link to read more:
https://www-nejm-org.ezproxy.hsc.usf.edu/doi/10.1056/NEJMoa2106356?url_ver=Z39.88-
2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed