Gradual discontinuation of antidepressants associated with less recurrence

January 01, 0001

Gradual discontinuation of antidepressants associated with less recurrence

These US authors compared illness recurrence after rapid versus gradual discontinuation of antidepressants. They compared 398 patients with a DSM-IV diagnosis of recurrent major depressive disorder (N=224), panic disorder (N=75), bipolar II disorder (N=62), or bipolar I disorder (N=37). Two- thirds were women, the mean age was 42 years, and patients were treated with antidepressants for a mean of 8.5 months. Antidepressants were discontinued clinically, either rapidly (over 1-7 days; N=188) or gradually (over 14 days or more; N=210), with a mean follow-up duration of 2.8 years; patients who were ill at discontinuation were excluded from the analysis.

They found: "The latency to first illness with rapid discontinuation was 0.4 times that with gradual discontinuation, and the latency after rapid discontinuation was one-fourth the estimated average previous interepisode interval in the same patients. The effect was similar across antidepressant classes and across years; the pace of discontinuation had less effect with drugs of prolonged half-life. The effect also varied by diagnosis (bipolar I greater than panic greater than bipolar II greater than major depressive disorder) but not by episodes per year, duration of index illness, use of concomitant treatment, or antidepressant dose or duration."

The authors concluded: "The recurrence risk for depression or panic was much shorter after rapid than after gradual discontinuation of antidepressants. These findings have implications for both clinical management and the design and interpretation of clinical trials."

It does seem to benefit patients to withdraw antidepressants gradually.

For the full abstract, click here.

Am J Psychiatry 167:934-941, September 2010
© 2010 American Psychiatric Association
Illness Risk Following Rapid Versus Gradual Discontinuation of Antidepressants. Ross J. Baldessarini, Leonardo Tondo, Carmen Ghiani, and Beatrice Lepri. Correspondence to Dr. Baldessarini:

Category: P. Psychological. Keywords: depression, antidepressants, recurrence, drug therapy, discontinuation, cohort study, journal watch.
Synopsis edited by Dr Linda French, Toledo Ohio. Posted on Global Family Doctor 21 September 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.