Abstract
BackgroundAntidepressant use has increased exponentially in recent decades, mostly due to long continuation.AimTo assess the effectiveness of a tailored recommendation to withdraw antidepressant treatment.Design & settingRandomised controlled trial in primary care (PANDA study) in the Netherlands.MethodLong-term antidepressant users (≥9 months) were selected from GPs prescription databases. Patients were diagnosed with the Composite International Diagnostic Interview (CIDI). Long-term users without indication for maintenance treatment (overtreatment) were selected. The intervention consisted of disclosure of the current psychiatric diagnosis combined with a tailored treatment recommendation. Patients were followed for 12 months.ResultsThe study included 146 participants from 45 family practices. Of the 70 patients in the intervention group, 34 (49%) did not comply with the advice to stop their antidepressant medication. Of the 36 (51%) patients who agreed to try, only 4 (6%) succeeded. These figures were consistent with the control group, where 6 (8%) of the 76 patients discontinued antidepressant use successfully. Patients who were recommended to discontinue their antidepressant medication reported a higher relapse rate than the control group (26% versus 13%, P = 0.05).ConclusionChanging inappropriate long-term antidepressant use is difficult.
Highlights
This study shows the difficulty of discontinuing inappropriate long-term antidepressant use
Even when intending to comply, more than half (56%) did not
The number of patients in the control group spontaneously discontinuing their antidepressant was similar to the number of patients discontinuing their antidepressant in accordance with the recommendation
Summary
During the 1990s, antidepressants were promoted widely and GPs were criticised for underdiagnosing and undertreating depressive and anxiety disorders. Efforts were made to increase quality of care, and prescription rates for antidepressants increased.4contrary concerns are raised concerning overtreatment with antidepressants. Long-term continuation contributes to the high level of antidepressant use. Studies suggest that many longterm users are exposed to antidepressants unnecessarily. One-third of long-term antidepressant users have been found to have no identifiable justification. In addition, a lack of medication review during the continuation of antidepressant treatment has been highlighted. Clinical guidelines recommend limiting the duration of antidepressants to 6 months after remission for a first or second depressive episode or a successfully treated anxiety disorder. The guidelines state that if after 4–6 weeks no remission has occurred, the medication should be switched to another antidepressant; if after another period of 4–6 weeks no remission has occurred, the guidelines advocate referral to a psychiatrist.. During the 1990s, antidepressants were promoted widely and GPs were criticised for underdiagnosing and undertreating depressive and anxiety disorders.. Long-term continuation contributes to the high level of antidepressant use.. Studies suggest that many longterm users are exposed to antidepressants unnecessarily.. One-third of long-term antidepressant users have been found to have no identifiable justification.. A lack of medication review during the continuation of antidepressant treatment has been highlighted.. Clinical guidelines recommend limiting the duration of antidepressants to 6 months after remission for a first or second depressive episode or a successfully treated anxiety disorder.. The guidelines state that if after 4–6 weeks no remission has occurred, the medication should be switched to another antidepressant; if after another period of 4–6 weeks no remission has occurred, the guidelines advocate referral to a psychiatrist.
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