People who stay on anti-depressants long-term are less likely to suffer a relapse than those who come off them, new research suggests.
The major study, which is the first in many years to compare people taking anti-depressants with those stopping them, found that when people stopped taking the pills after a long period of use, just over half (56 per cent) experienced a relapse within a year, compared with 39 per cent of those who stayed on medication.
Experts behind the research said the study supports current prescribing and dismisses the idea that people taking anti-depressants in the long-term are taking them unnecessarily.
However, they also said the study shows that, if people are given the right support, many can also come off the drugs safely.
The research, published in the New England Journal of Medicine, included 478 patients in England, all of whom were on common anti-depressants such as citalopram, sertraline, fluoxetine or mirtazapine.
Most (70 per cent) of those in the study had been taking the medication for more than three years (and all for at least nine months), and had gone on the drugs following at least two bouts of depression.
Some 73 per cent of people in the study were women, 95 per cent were white, and they ranged in age from 18 to 74, with an average age of 54.
When the research started, all of those involved felt well enough to stop their medication.
During the study, half of the patients (238) were randomly allocated to continue with their usual dose of anti-depressants, while the other half (240) discontinued the drugs.
This discontinuation group gradually tapered off the medication they had been taking over a two-month period.
People were interviewed six weeks after the trial started, then again at 12 weeks, 26 weeks, 39 weeks and 52 weeks.
The results showed that patients who tapered off their anti-depressants experienced a relapse sooner than the patients who stayed on their tablets.
At the 52-week point, 56 per cent of people who stopped their antidepressants had experienced a relapse compared with 39 per cent of people who stayed on their anti-depressants.
The results further showed that, at the 12-week point, symptoms of depression and anxiety were higher in the group tapering off their medication.
Those staying on the pills also had a higher quality of life related to their mental health than those coming off them, the study found.
Despite this, by the end of the study, 59 per cent of the discontinuation group were no longer taking anti-depressants.
Around half of those who stopped taking their pills and had a relapse – with persistent depressive symptoms – went back on the drugs.
Lead author Dr Gemma Lewis, from University College London, told a briefing: “To summarise the findings, what we found was that long-term anti-depressants do help to reduce the risk of relapse.
“However, staying on anti-depressants did not guarantee that someone remained free from relapse over the course of the trial.
“And we also found that many people can stop their medication without relapsing, although at present we cannot identify who those people are.”
She said that because 44 per cent of those who discontinued their anti-depressants did not relapse after a full year, some patients may wish to stop and should consult their doctor.
Professor Tony Kendrick, from the University of Southampton, who worked on the study, said: “I think we can be very cheered by these findings.
“We know now that the risk of relapse is reduced by staying on your anti-depressant.
“We also know that not everyone who stays on their anti-depressant is free from relapse, and not everyone who stops their anti-depressant relapses.
“So it’s very reasonable if you’re taking long-term anti-depressants and you’re unsure if you want to stop them, to discuss with your doctor or other prescriber the possibility of coming off them.
“And there is evidence to show that if you stay on them, and you’re not experiencing side-effects and you’re happy to stay on them, you will reduce the risk of relapse.”
He said that the best way of cutting the risk of relapse may be to combine drugs with psychological therapy.
But he added: “It’s reassuring to know that the anti-depressants that a lot of people are taking long-term do seem to be benefiting them, and this is not something that they’re taking unnecessarily.”
Senior author Professor Glyn Lewis, from University College London, said: “Overall this supports current prescribing within primary care.
“There has been a concern that people have been on anti-depressants for years, even decades, and we haven’t really known in a sense, because of the evidence base, whether there was still a benefit for them to remain on the anti-depressants.
“But what this study convincingly demonstrates is that yes, there is a benefit for staying on long term anti-depressants.
“On average, people will reduce the risk of relapse if they stay on their anti-depressant long term.
“I would say that it kind of supports the idea that the way the anti-depressants are being used at the moment is appropriate and is overall benefiting patients.
“Having said that, the research question here really is ‘can we find out which people are benefiting and which people aren’t?’”
Co-lead author Dr Louise Marston, from University College London, said: “We do not yet know why some people seem able to come off their anti-depressants and some cannot, so further research may help us to predict who can stop anti-depressants safely.”
The experts said anti-depressants seem to be very well tolerated with few side-effects, but there is some evidence that those who have been on them for a long time can suffer health issues, such as worse heart disease or increased risk of stroke and seizures, as they get older.
However, they said existing evidence means it is difficult to tell whether anti-depressants are causing these issues or whether it is something else.
Figures from the NHS Business Services Authority show that more than 20 million anti-depressants were prescribed between October and December 2020 — a 6 per cent increase compared with the same three months in 2019.
The use of anti-depressants has been steadily increasing since 2015.
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