Continuing antidepressants or not: Evaluating the potential benefits and harms

Abstract

Background: Many Australians use antidepressants for longer periods, and for less severe conditions, than current guidelines recommend. Recent commentary has explored the rationale for stopping antidepressants, but overlooked flaws in the evidence for continuing antidepressants long- term.

Objective: To critically appraise the evidence for continuing antidepressants long-term (>12 months).

Discussion: The evidence for long-term use of antidepressants stems primarily from discontinuation studies in which people taking antidepressants are randomised to either stop or continue. These studies do not distinguish withdrawal symptoms from relapse. Worsening mood/anxiety in the discontinued group is interpreted as relapse and findings interpreted as evidence that long-term therapy prevents relapse, ignoring the possibility that the apparent benefits of continuing antidepressants might lie in suppressing withdrawal symptoms. Due to the lack of robust evidence for benefit, and established evidence showing harm with long-term use, antidepressant treatment should be regularly reviewed with shared decision making about whether to continue or stop.