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Internet and Telephone Support for Discontinuing Long-Term Antidepressants: The REDUCE Cluster Randomized Trial.
Tony Kendrick1, Beth Stuart2, Hannah Bowers1
1Primary Care Research Centre, School of Primary Care, Population Health & Medical Education, Faculty of Medicine, University of Southampton, Aldermoor Health Centre, Southampton, United Kingdom.
JAMA Network Open
|June 24, 2024
Summary
Adding internet and telephone support to family practitioner review for long-term antidepressant discontinuation was safe and slightly improved depression scores. While antidepressant discontinuation rates did not significantly increase, patients experienced fewer withdrawal symptoms and better mental well-being.
Area of Science:
- Clinical Medicine
- Psychiatry
- Health Services Research
Background:
- Long-term antidepressant use is increasing, raising concerns about exceeding evidence-based durations.
- Determining safe and effective strategies for antidepressant discontinuation is crucial.
Purpose of the Study:
- To evaluate the safety and efficacy of adding internet and telephone support to family practitioner review for discontinuing long-term antidepressant treatment.
- To compare this combined approach against practitioner review alone.
Main Methods:
- A cluster randomized clinical trial involving 131 UK family practices and 330 adult participants on long-term antidepressants.
- Participants were eligible if well enough to consider discontinuation and at low relapse risk.
- Intervention involved internet/telephone self-management support alongside practitioner review; control received practitioner review only.
Main Results:
- The intervention was noninferior for depression scores at 6 months (PHQ-9: 4.0 vs 5.0).
- Antidepressant discontinuation rates were similar (45.5% vs 41.9%).
- The intervention group showed significantly fewer antidepressant withdrawal symptoms and improved mental well-being, though differences were small.
Conclusions:
- Adding internet and telephone support to practitioner review for antidepressant discontinuation is safe.
- This approach may offer slight benefits in depression, withdrawal symptoms, and mental well-being.
- Practitioner-led review alone is safe and effective for a substantial proportion of patients willing to discontinue antidepressants.
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