Discontinuation of antidepressants: Is there a minimum time on treatment that will reduce relapse risk?
Antidepressant
Cohort
Discontinuation
Duration of treatment
Population-based
Relapse
Journal
Journal of affective disorders
ISSN: 1573-2517
Titre abrégé: J Affect Disord
Pays: Netherlands
ID NLM: 7906073
Informations de publication
Date de publication:
01 07 2021
01 07 2021
Historique:
received:
24
12
2020
revised:
12
03
2021
accepted:
25
04
2021
pubmed:
20
5
2021
medline:
6
7
2021
entrez:
19
5
2021
Statut:
ppublish
Résumé
Several national guidelines include recommendations for a minimum duration of antidepressant treatment, but these vary from 4-9 months after remission. We aimed to investigate whether there is an optimal minimum duration of antidepressant treatment to reduce relapse risk. A Danish population-based cohort study among 89,442 adults who initiated antidepressants for depression treatment aged 18-60 years, from 2006-2015. We defined antidepressant discontinuation as ≥30 days without treatment. We estimated hazard ratios (HRs) with 95% confidence intervals (CIs) to indicate the risk of restarting antidepressants among those who discontinued antidepressants with <4, 4-6, and 7-9 months of use compared with discontinuation after 10-12 months. For individuals on antidepressant treatment <4, 4-6, 7-9 and 10-12 months, cumulative incidence of restarting treatment within one year was 37.4% (95% CI: 36.9-37.8%), 35.1% (95% CI: 34.6-35.7%), 35.0% (95% CI: 34.2-35.8%) and 32.8% (95% CI: 31.7-34.0%), respectively. Individuals on antidepressants <10 months versus 10-12 months had higher risk of restarting antidepressants: the HR for antidepressant treatment <4 months was 1.21 (95% CI: 1.16-1.27), 4-6 months 1.11 (95% CI: 1.06-1.17), and 7-9 months 1.09 (95% CI: 1.04-1.15). We were not able to ascertain the reasons why individuals discontinued antidepressants, and systematic errors from unmeasured confounders cannot be ruled out. Based on our findings, a minimum of 10-12 months of treatment appears to be preferable if there is concern about relapse after discontinuation.
Sections du résumé
BACKGROUND
Several national guidelines include recommendations for a minimum duration of antidepressant treatment, but these vary from 4-9 months after remission. We aimed to investigate whether there is an optimal minimum duration of antidepressant treatment to reduce relapse risk.
METHODS
A Danish population-based cohort study among 89,442 adults who initiated antidepressants for depression treatment aged 18-60 years, from 2006-2015. We defined antidepressant discontinuation as ≥30 days without treatment. We estimated hazard ratios (HRs) with 95% confidence intervals (CIs) to indicate the risk of restarting antidepressants among those who discontinued antidepressants with <4, 4-6, and 7-9 months of use compared with discontinuation after 10-12 months.
RESULTS
For individuals on antidepressant treatment <4, 4-6, 7-9 and 10-12 months, cumulative incidence of restarting treatment within one year was 37.4% (95% CI: 36.9-37.8%), 35.1% (95% CI: 34.6-35.7%), 35.0% (95% CI: 34.2-35.8%) and 32.8% (95% CI: 31.7-34.0%), respectively. Individuals on antidepressants <10 months versus 10-12 months had higher risk of restarting antidepressants: the HR for antidepressant treatment <4 months was 1.21 (95% CI: 1.16-1.27), 4-6 months 1.11 (95% CI: 1.06-1.17), and 7-9 months 1.09 (95% CI: 1.04-1.15).
LIMITATIONS
We were not able to ascertain the reasons why individuals discontinued antidepressants, and systematic errors from unmeasured confounders cannot be ruled out.
CONCLUSIONS
Based on our findings, a minimum of 10-12 months of treatment appears to be preferable if there is concern about relapse after discontinuation.
Identifiants
pubmed: 34010750
pii: S0165-0327(21)00377-3
doi: 10.1016/j.jad.2021.04.045
pmc: PMC8739188
mid: NIHMS1766073
pii:
doi:
Substances chimiques
Antidepressive Agents
0
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
254-260Subventions
Organisme : NIMH NIH HHS
ID : R01 MH122869
Pays : United States
Informations de copyright
Copyright © 2021. Published by Elsevier B.V.
Références
Can J Psychiatry. 2016 Sep;61(9):540-60
pubmed: 27486148
Scand J Public Health. 2016 Jul;44(5):462-79
pubmed: 27098981
BMJ. 2015 Feb 18;350:h517
pubmed: 25693810
Soc Psychiatry Psychiatr Epidemiol. 2019 Dec;54(12):1545-1553
pubmed: 30888432
BMC Med. 2011 Jul 26;9:90
pubmed: 21791035
J Clin Psychiatry. 2014 Mar;75(3):205-14
pubmed: 24717376
Scand J Public Health. 2011 Jul;39(7 Suppl):54-7
pubmed: 21775352
Scand J Public Health. 2011 Jul;39(7 Suppl):22-5
pubmed: 21775345
Mol Psychiatry. 2021 Jan;26(1):118-133
pubmed: 32704061
JAMA. 2002 Sep 18;288(11):1403-9
pubmed: 12234237
Expert Rev Neurother. 2007 Jan;7(1):57-62
pubmed: 17187497
J Affect Disord. 2016 May 15;196:138-47
pubmed: 26921866
Pharmacoepidemiol Drug Saf. 2018 Oct;27(10):1131-1138
pubmed: 29664233
Psychother Psychosom. 2004 Jul-Aug;73(4):255-8
pubmed: 15184721
Lancet. 2018 Nov 10;392(10159):1789-1858
pubmed: 30496104
J Clin Psychiatry. 2001;62 Suppl 22:30-3
pubmed: 11599645
Lancet. 2018 Apr 7;391(10128):1357-1366
pubmed: 29477251
Clin Epidemiol. 2011;3:203-11
pubmed: 21750629
Pharmacoepidemiol Drug Saf. 2010 Jan;19(1):33-7
pubmed: 19998397
J Psychopharmacol. 2009 Nov;23(8):967-74
pubmed: 18635702
Clin Epidemiol. 2015 Nov 17;7:449-90
pubmed: 26604824
Multivariate Behav Res. 2011 May;46(3):399-424
pubmed: 21818162
Am J Psychiatry. 2006 Jan;163(1):28-40
pubmed: 16390886
PLoS One. 2011 Mar 28;6(3):e18241
pubmed: 21464898
Psychother Psychosom. 2018;87(4):195-203
pubmed: 30016772
Scand J Public Health. 2011 Jul;39(7 Suppl):38-41
pubmed: 21775349
Am J Psychiatry. 2010 Aug;167(8):934-41
pubmed: 20478876