Coming off anti-depressants may not cause relapse - study

Many people who have taken anti-depressants for at least two years may be able to stop them without relapsing, but most will still need long-term treatment, a UK study suggests.

Prescriptions for the drugs have more than doubled in the past 15 years because people are staying on them for much longer.

But it's not clear how well they work over many years.

The researchers say they want to find out who is benefitting and who isn't.

Their findings, published in The New England Journal of Medicine, show 44% of people who gradually stopped taking their anti-depressants did not have another bout of depression in the following year.

Of people who continued to take their medication as normal, 61% did not relapse.

'Not ideal for everyone'

Study author Dr Gemma Lewis, from University College London, said: "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."

The researchers said it was important to consult a doctor before doing this. They also said psychological therapies could help prevent a relapse, although there was often a waiting list.

Prof Glyn Lewis, also from UCL, said: "Anti-depressants are effective but, like many medications, are not ideal for everyone."

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The 478 adults involved in the study were recruited from 150 GP surgeries across England, and all had been taking anti-depressants for at least two years and felt ready to come off them.

They were separated into two groups - in one, people continued to take their medication while in another, their drugs were tapered off over three months - and followed up for a year.

Of those who stopped taking anti-depressants, 56% said they relapsed or felt depressed again for more than two weeks at some point. They were also more likely to experience symptoms of withdrawal, which could be confused with a relapse and may mean some people need to come off the drugs more slowly, the researchers said.

Despite this, only half chose to start taking anti-depressants again, and by the end of the study, 59% of the group who had stopped the drugs were no longer taking any depression medication.

Even in the group which continued taking their medication, more than a third said they felt depressed at some stage.

Long-term use

The research team does not know why some people seem able to come off their anti-depressants and some cannot, but predicting who can stop them safely is the next challenge.

With prescriptions for anti-depressants increasing, there are concerns that more and more people could end up taking them for life - and the risks of long-term use are still unclear.

Study author Prof Tony Kendrick, from the University of Southampton, says long-term use in people over 65 may be leading to more falls, strokes and seizures - but the overall risks are low, and it is not known whether it is the drugs causing these issues, or underlying health problems.

Younger middle-aged patients reported far fewer side-effects from taking anti-depressants for many years.

Prof Kendrick said he was "cheered" by the findings which showed people were not taking the drugs "unnecessarily".

The medications in the study are some of the most commonly prescribed - citalopram, sertraline, fluoxetine or mirtazapine. Other drugs, which are more difficult to withdraw from, were not studied.

'No right answer'

Professor Sir Simon Wessely, regius chair of psychiatry at King's College London, said the study was "very important", and would help patients make an informed choice.

"Yes, you can come off medication, provided it's done slowly, but there is a small, but not insignificant, risk of another illness," he said.

"As ever there is no right answer, but this study provides more information to assist people in making up their minds."

Mental health charity Mind said it wanted to make sure that people have access "to a range of treatments and are able to have open discussions with their GP".

These discussions should include any possible side effects so people feel they can change or withdraw from medication safely, it said.

Researchers from the universities of York, Southampton and Bristol, and McMaster University in Canada, were also involved in the study.