Authors of a United Kingdom (UK) study published in this week’s issue of The Lancet highlight how longer-term use of antidepressants-by a year or more in addition to standard 4-6 month treatment-could substantially reduce the risk of relapse for people with depressive disorders.
Depression is a leading cause of illness and death worldwide. Short-term and medium-term therapy with antidepressants (usually four to six months) is often effective in alleviating depressive symptoms; however the long-term nature of many depressive disorders and the risk of many people to relapse after treatment begs the question: how long should antidepressants be taken?
John Geddes and colleagues from the University of Oxford, UK, pooled data from 31 randomized trials which included around 4,400 patients. All participants in the trials had already received treatment for acute depressive disorders and were randomized to receive continuous treatment with antidepressants or placebo.
Treatment for one or two years with antidepressants substantially reduced the likelihood of relapse compared with those who discontinued active treatment. The average rate of relapse on placebo was around double that of treatment, 41% compared with 18%. The proportional reduction in risk of depressive relapse was generally independent of the underlying risk of relapse, the duration of treatment before randomization, or the duration of short-term and medium-term therapy.
Co-author Guy Goodwin comments: “Few other interventions in psychiatry are supported by such robust findings, based on more than 4,000 patients in randomized trials. We know that many patients remain at appreciable risk of recurrence after 4-6 months of treatment with antidepressants, and another one or two years of continuation treatment will approximately halve their risk of another episode. In other words, the positive benefits of antidepressants do not wear off over time. Many patients who do exceptionally well may elect to take such medicines indefinitely rather than increase the risk of further illnesses by stopping. ”