How difficult is it to stop taking antidepressant pills?

From Therapeutic Advances in Psychopharmacology
Published in association with the British Association for Psychopharmacology

By Peter Lucassen

“A lot of people are taking antidepressant pills, nowadays. Mostly, these people suffer from depression. When you take antidepressant pills for depression, a course of 3 to 6 months is enough, most of the time. After that period the depression is over, and you can stop taking the pills. However, some patients find it difficult to stop taking the pills because they are afraid that the depressive symptoms will return. And sometimes their physician is also afraid of this. As a result, many patients take their antidepressant pills for too long.

Because of this problem we started a study, we wanted to know whether advice from the general practitioner to stop the medication and how to do that would be sufficient to help patients stop taking the antidepressant pills. So, we asked general practitioners to participate and we searched in their files for patients taking antidepressant pills for 9 months or longer. We sent these patients a questionnaire to determine whether they had a good medical reason for taking antidepressant pills for such a long time. If yes, they would not receive the advice to stop. We also assessed if the patient was still depressed or not. Patients who were not depressed anymore received the advice from their general practitioner to stop and how to do that. We (a psychiatrist and a general practitioner from the research team) had sent that advice to the general practitioner based on the results of the questionnaire that the patient had filled in. For scientific reasons we had to use a control group of patients. These patients were also taking antidepressant pills for 9 months or longer, and also filled in the questionnaires. But these patients received no advice from their general practitioner to stop taking the pills.

We had 70 patients who received the advice to stop. Of these 70 patients 34 did not follow the advice to stop taking the pills; of the 36 patients who agreed to try, only 4 succeeded to really stop taking antidepressants. In the control group there were 76 patients of whom 6 stopped taking antidepressant pills, although they had not received the advice to stop. So, there was no difference between receiving an advice from the general practitioner and not receiving advice. A striking finding was that the patients in the group that received advice to stop, suffered more often from new depression symptoms. We think that this might be related to anxiety: being advised to stop possibly provoked anxiety for returning symptoms, which provoked the new symptoms. We also assume that many patients are made to believe that depression is a chronic condition and thus need permanent medication.

So, it is hard to stop taking antidepressant pills. Other new research has also shown the low pace with which the antidepressant medication has to be discontinued. In our study we discontinued the medication gradually in 8 weeks. We now assume that the tapering period should be longer.

We think that it is worthwhile to try to stop antidepressants when you are not suffering from depression anymore. An exception is when you have had very severe depression or 3 or more episodes of depression. Our advice is not to stop on your own but to do so in collaboration with your own doctor.”

Article details

Patients’ attitudes to discontinuing not-indicated long-term antidepressant use: barriers and facilitators
Rhona Eveleigh, Anne Speckens, Chris van Weel, Richard Oude Voshaar and Peter Lucassen
First Published September 3, 2019 Research Article
DOI: 10.1177/2045125319872344
From Therapeutic Advances in Psychopharmacology

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