Continuing antidepressants or not: Evaluating the potential benefits and harms

Area of Science:

• Psychiatry
• Pharmacology
• Clinical Medicine

Background:

• Many Australians use antidepressants longer than recommended.
• Current guidelines may not reflect long-term antidepressant efficacy.
• Evidence for continuing antidepressants long-term needs critical appraisal.

Purpose of the Study:

• To critically appraise the evidence supporting the long-term continuation of antidepressant therapy (>12 months).

Main Methods:

• Review of discontinuation studies where participants stop or continue antidepressants.
• Analysis of how outcomes in discontinued groups are interpreted.

Main Results:

• Discontinuation studies do not differentiate between antidepressant withdrawal symptoms and relapse.
• Apparent benefits of continuing antidepressants may stem from suppressing withdrawal.

Conclusions:

• The evidence base for long-term antidepressant use is primarily based on flawed discontinuation studies.
• Lack of robust evidence for long-term benefit, coupled with known harms, necessitates regular treatment reviews.
• Shared decision-making between patients and clinicians is essential for managing antidepressant continuation or cessation.