timothy wand

Not very long so full text here: The importance of minimising long-term antidepressant use We recently argued that patients prescribed antidepressants should undergo regular review to consider whether continued prescribing or deprescribing is indicated.1 The evidence supporting continued treatment is flawed since discontinuation trials showing that continuation of antidepressants prevents relapse are likely to be confounded by withdrawal symptoms. This applies to the Geddes meta-analysis, mentioned by Looi et al,2 in which antidepressants were typically stopped abruptly or over only a few days. Such rapid discontinuation is well recognised to produce withdrawal symptoms that overlap with relapse measures, fundamentally undermining confidence in estimates of relapse prevention.3 Alongside doubtful evidence of benefit, there is clear evidence of harm with continuing antidepressants long term including emotional numbing, sexual dysfunction, weight gain, diabetes and, in older adults, increased risks of falls, fractures and possibly premature mortality. Looi et al agree that antidepressants should be reviewed regularly and discontinued when harms outweigh benefits. However, they do not address our central argument regarding the methodological limitations of discontinuation trials concerning their confounding by withdrawal symptoms. Looi et al also provide no evidence supporting their assertion that antidepressants remain beneficial for long-term treatment of recurrent moderate-to-severe depression. Long-term antidepressant use may only be beneficial in preventing withdrawal symptoms. Recent Australian data indicate that antidepressants are overwhelmingly prescribed by general practitioners (91%), unchanged from 2007 to 2011.4 Looi et al question whether evidence on antidepressant withdrawal symptoms from a UK National Health Service cohort is generalisable to Australia. There is no biological reason why withdrawal phenomena should differ between British and Australian patients. There is a growing body of international literature showing that patients can experience severe and prolonged withdrawal symptoms, particularly after long-term antidepressant use.5,6 Whether antidepressants should be continued long term and how to help patients who wish to stop taking antidepressants are important clinical questions. Reliable evidence supporting maintenance treatment is lacking, while there is evidence of harm.

The Australian Journal of General Practice from @RACGP published out letter today titled 'The importance of minimising long-term antidepressant use'. Given there is no robust evidence of benefit (discontinuation trials are confounded and not reliable) but evidence of harm we should be aiming to minimise long term use of these medications. Link below.