- Researchers report that more than half of participants in a recent study relapsed to depression after they stopped taking antidepressant medications.
- Experts say some people need to keep taking antidepressants longer, while others can avoid relapses after stopping their medication use.
- They say people who do stop taking antidepressants should consult with their doctor first and perhaps participate in therapy sessions for at least a while.
A majority of people who stop taking long-term antidepressant medication relapse to depression within a year, a new study finds.
But that might not be as serious as it sounds.
Researchers from University College London found that 56 percent of people who stopped taking long-term antidepressants such as citalopram, sertraline, fluoxetine, and mirtazapine experienced a relapse within 12 months.
That compared to a 39 percent relapse rate among people who kept taking their medication.
“Although we see a higher rate of relapse for those assigned to the discontinuation group, it’s notable that it appears that the medication, when taken as prescribed/instructed, is working,” Dr. David H. Klemanski, assistant professor of psychiatry at the Yale New Haven Hospital, told Healthline.
Conversely, the study found that 44 percent of participants who quit taking antidepressants did not relapse.
“Prescriptions of antidepressants have increased dramatically over recent decades as people are now taking antidepressants for much longer,” said Gemma Lewis, PhD, lead author of the study and a mental health sciences lecturer at University College London, in a statement.
“Until now, we didn’t know whether antidepressant treatment was still effective when someone has been taking them for many years. We have found that taking antidepressants long-term does effectively reduce the risk of relapse. However, many people can stop their medication without relapsing, though at present we cannot identify who those people are,” she said.
“The good news is that people don’t necessarily have to keep taking medication for the rest of their lives. For people who experience negative side effects from their medications, that’s great,” Dr. Nima Fahimian, medical director at TMS & Brain Health in Los Angeles, told Healthline.
The randomized, double-blind controlled study involved 478 people in England who were taking long-term antidepressants — most for 3 years or longer — but felt well enough to try stopping.
Half of the study participants stopped taking their medications, while the rest continued. The cessation group was given tapered doses for several weeks before being switched to placebo pills.
“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 2 months,” said Lewis.
The severity of relapses was not measured. However, 59 percent of people who experienced relapses chose not to resume taking their medication after the study ended.
Researchers said that could indicate that the relapse or accompanying withdrawal symptoms may not have been severe enough to prompt people to resume taking antidepressants.
“Many patients taking antidepressants long-term have absolutely no idea what they would be like without antidepressants,” said Paul Lanham, the study’s “lived experience” researcher, in a statement. “Some will not want to find out, but others will. These results show that continuing to take antidepressants does reduce the risk of relapse, but it does not guarantee well-being, and some people can stop antidepressants without a relapse.”
The study authors urged people taking antidepressant medication to discuss any decisions about discontinuing use of these drugs with their doctor first.
“For those who are willing to work with a physician and are willing to carefully track mood symptoms and can evaluate with their medical team when to stop and/or restart medications, it may be a helpful course to pursue,” said Klemanski. “But as we know based on this study and similar others, antidepressants used outside of the acute phase can have helpful and positive effects.”
“The case to keep taking antidepressants is simply always going to be a matter of risk and reward: How serious is your depression, and are you at particular risk of suicide?” said Fahimian.
“If one tends to go through serious phases of depression, where someone cannot continue working, has to go on disability, or attempts suicide, the slight increase in likelihood of preventing relapse is probably worth it. If the depression is more mild in general, and the antidepressant side effects are not particularly tolerable, one can make a case for discontinuation,” he said.
People who do choose to stop taking antidepressants likely would benefit from counseling, Fahimian said.
“Therapy could, and most likely does, help mitigate some of the negative effects of stopping medication,” Fahimian said. “Most studies have shown that counseling in conjunction with medication is far superior to medication alone. Ultimately, it varies between cases, the individual’s history, and genetics.”
“There is excellent research that shows cognitive and cognitive behavioral therapies can be as effective in treating depression as are antidepressant medications” and “can have enduring effects that can protect, to a degree, against relapse and recurrence,” said Klemanski.