Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults

Leeuwen, Ellen Van; Driel, Mieke van; Horowitz, Mark; Kendrick, Tony; Donald, Maria; Sutter, An IM De; Robertson, Lindsay; Christiaens, Thierry

doi:10.1002/14651858.cd013495.pub2

Cited by 41 publications

(68 citation statements)

References 248 publications

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“…The risk of relapse during and after discontinuation is realistic but seems to be lower than estimated by our GPs. An important group of people on long-term antidepressants can stop the antidepressant [ 27 ]. There is also evidence that when supported by psychotherapy, 40–75% of people with recurrent depression are able to discontinue their antidepressants [ 28–30 ].…”

Section: Discussionmentioning

confidence: 99%

‘Never change a winning team’: GPs’ perspectives on discontinuation of long-term antidepressants

Ellen

Anthierens

Driel

et al. 2021

Scandinavian Journal of Primary Health Care

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Background Long-term antidepressant use, much longer than recommended by guidelines, can harm patients and generate unnecessary costs. Most antidepressants are prescribed by general practitioners (GPs) but it remains unclear why they do not discontinue long-term use. Aim To explore GPs’ views and experiences of discontinuing long-term antidepressants, barriers and facilitators of discontinuation and required support. Design and setting Qualitative study in Belgian GPs. Method 20 semi-structured face-to-face interviews with GPs. Interviews were analysed thematically. Results The first theme, ‘Success stories’ describes three strong motivators to discontinue antidepressants: patient health issues, patient requests and a new positive life event. Second, not all GPs consider long-term antidepressant use a ‘problem’ as they perceive antidepressants as effective and safe. GPs’ main concern is the risk of relapse. Third, GPs foresee that discontinuation of antidepressants is not an easy and straightforward process. GPs weigh up whether they have the necessary skills and whether it is worth the effort to start this process. Conclusion Discontinuation of long-term antidepressants is a difficult and uncertain process for GPs, especially in the absence of a facilitating life-event or patient demand. The absence of a compelling need for discontinuation and fear of relapse of symptoms in a stable patient are important barriers for GPs when considering discontinuation. In order to increase GPs’ motivation to discontinue long-term antidepressants, more emphasis on the futility of the actual effect and on potential harms related to long-term use is needed. KEY POINTS Current awareness: Long-term antidepressant use, much longer than recommended by guidelines, can harm patients and generate unnecessary costs. Main statements: • Discontinuation of long-term antidepressants is a difficult and uncertain process for GPs. • More emphasis on the futility of the actual effect of antidepressants and on potential harms related to long-term use is needed.

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Section: Discussionmentioning

confidence: 99%

‘Never change a winning team’: GPs’ perspectives on discontinuation of long-term antidepressants

Ellen

Anthierens

Driel

et al. 2021

Scandinavian Journal of Primary Health Care

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“…We must first acknowledge that there is a paucity of evidence to answer this question: in a recent Cochrane review only 33 randomised controlled trials examining antidepressant discontinuation were identified. 44 The majority of these were uninformative because they mostly stopped antidepressants abruptly or in less than 4 weeks, only one measured withdrawal symptoms, and most were at high risk of bias because detection of relapse was confounded by withdrawal symptoms. 44 There are observational trials that have found that tapering antidepressants over months and to doses much lower than those used in clinical practice generally have better outcomes than tapering over weeks to 25% or 50% of the dose of currently available tablet formulations.…”

Section: How To Discontinuementioning

confidence: 99%

“…44 The majority of these were uninformative because they mostly stopped antidepressants abruptly or in less than 4 weeks, only one measured withdrawal symptoms, and most were at high risk of bias because detection of relapse was confounded by withdrawal symptoms. 44 There are observational trials that have found that tapering antidepressants over months and to doses much lower than those used in clinical practice generally have better outcomes than tapering over weeks to 25% or 50% of the dose of currently available tablet formulations. 55 In particular, one observational study found that reducing doses over months down to as low as 0.5% of clinically used doses (eg, 0.1 mg of paroxetine and 1 mg of venlafaxine) allowed the majority (71%) of a group of patients to cease their antidepressant.…”

Section: How To Discontinuementioning

confidence: 99%

Newer generation antidepressants and withdrawal effects: reconsidering the role of antidepressants and helping patients to stop

Horowitz

Wilcock

2021

DTB

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In England, the prescribing of antidepressants, primarily the newer generation antidepressant classes, has steadily increased over recent years. There is ongoing debate about how the efficacy of these drugs is viewed, their place in therapy and the harms associated with stopping them. Much of the evidence of their efficacy comes from short-term placebo-controlled trials which tend not to include outcomes that are of greatest relevance to patients, such as social functioning or quality of life, but rather restrict outcomes narrowly to symptom measures. On such measures these studies do not demonstrate clinically significant differences from placebo for depression. A range of adverse effects are also recognised, often greater in naturalistic studies of long-term antidepressants users than those measured in short-term efficacy studies, including emotional numbing, sexual difficulties, fatigue and weight gain. There is increasing recognition that withdrawal symptoms from antidepressants are common and that these symptoms can be severe and long-lasting in some patients. Recent guidance on how to stop antidepressants in a tolerable way has been presented by the Royal College of Psychiatrists. We believe that increasing awareness about the difficulty that some patients have in stopping antidepressants should lead to more cautious prescribing practice, with antidepressants given to fewer patients and for shorter periods of time. This article discusses the perceived benefits and harms of antidepressant use.

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“…Several studies have been conducted to investigate interventions that support the discontinuation of psychotropic medication and identify effective interventions that minimise the risk of relapse and withdrawal symptoms [20][21][22] . In many cases, the existing evidence base is limited.…”

Section: Psychotropic Medications Have Various Adverse Effectsmentioning

confidence: 99%

Mobile phone applications to support psychotropic tapering: a scoping review protocol

et al. 2022

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Background: In the context of a recovery-oriented approach to mental healthcare, the role of psychotropic medication over extended or indefinite periods is increasingly being called into question. To minimise the risks of withdrawal symptoms and relapse, it is crucial that service users who want to discontinue psychotropic medication are supported throughout the tapering process. However, in the absence of effective interventions and supports, service users are increasingly relying on online resources for guidance and support. To date, the evidence base for mobile phone applications (‘apps’) and app-based interventions supporting discontinuation of psychotropic use has not been examined. This scoping review aims to examine the content, underpinning evidence base and impact of available mobile phone apps and app-based interventions to support psychotropic tapering. Methods: A scoping review will be conducted using the Joanna Briggs Institute guidance and results will be reported using the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses extension for Scoping Reviews (PRISMA-ScR) guideline. Several electronic databases (MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, ACM and IEEE Xplore) will be searched from 2008 onwards. Searches of the major app stores will also be conducted, specifically Apple's App Store (iOS) and Google Play Store (Android). Following screening, key information will be extracted from the included studies and apps. Identified apps will be coded using the Behaviour Change Technique (BCT) Taxonomy. The findings will be described using narrative synthesis. Conclusions: This scoping review will provide a broad overview of available apps to support psychotropic tapering, including a summary of their content using the BCT Taxonomy. The review findings will guide future research relating to the development, implementation and evaluation of app-based interventions to support the tapering of psychotropic medication.

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Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults

Abstract: Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review)

Cited by 41 publications

References 248 publications

‘Never change a winning team’: GPs’ perspectives on discontinuation of long-term antidepressants

‘Never change a winning team’: GPs’ perspectives on discontinuation of long-term antidepressants

Newer generation antidepressants and withdrawal effects: reconsidering the role of antidepressants and helping patients to stop

Mobile phone applications to support psychotropic tapering: a scoping review protocol

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