Managing antidepressant discontinuation: a systematic review
Managing antidepressant discontinuation: a systematic review
Purpose
To determine the effectiveness of interventions to manage antidepressant discontinuation, and outcomes for patients.
Methods
Systematic review with narrative synthesis and meta-analysis. Sources: MEDLINE, PubMed, Embase, PsycINFO, AMED, Health Management Information Consortium (HMIC), OpenGrey, and WHO International Clinical Trials Registry Platform (ICTRP) to March 2017. Including: randomised controlled trials (RCTs), quasi-experimental, and observational studies assessing interventions to facilitate discontinuation of antidepressants for depression in adults. Primary outcomes: antidepressant discontinuation, and discontinuation symptoms. Secondary outcomes: relapse/ recurrence, quality of life, antidepressant reduction, sexual, social, and occupational function.
Results
Of 15 studies included, 12 were in the synthesis (8 RCTs, 2 single-arm trials, 2 retrospective cohort studies). None of the studies was rated high risk for selection or detection bias. Two studies prompting primary care provider (PCP) discontinuation with antidepressant tapering guidance found 6% and 7% of patients discontinued, versus 8% for usual care. Six studies of psychological or psychiatric treatment plus tapering reported cessation rates of between 40% and 95%. Two studies reported a higher risk of discontinuation symptoms with abrupt termination. At 2 years, risk of relapse/ recurrence was lower with cognitive behaviour therapy (CBT) plus taper versus clinical
management plus taper (15%-25% vs 35%-80%: RR 0.34, 95% CI 0.18 to 0.67; 2 studies).
Relapse/recurrence rates were similar for mindfulness based cognitive therapy (MBCT) with tapering and maintenance antidepressants (44%-48% vs 47%-60%; 2 studies).
Conclusions
CBT or MBCT can help patients discontinue antidepressants without increasing the risks of relapse/recurrence, but are resource intensive. More scalable interventions are needed, incorporating psychological support.
Antidepressants, prescribing, PRIMARY CARE
52-60
Maund, Emma
c9733167-eafe-44e5-b418-5ace79161402
Stuart, Beth
626862fc-892b-4f6d-9cbb-7a8d7172b209
Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Dowrick, Christopher
1869ad5e-1959-446c-b2a8-3fcdf3e79667
Geraghty, Adam
2c6549fe-9868-4806-b65a-21881c1930af
Dawson, Sarah
1689f00c-c088-4e64-85f4-253e727b05ec
Kendrick, Tony
c697a72c-c698-469d-8ac2-f00df40583e5
January 2019
Maund, Emma
c9733167-eafe-44e5-b418-5ace79161402
Stuart, Beth
626862fc-892b-4f6d-9cbb-7a8d7172b209
Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Dowrick, Christopher
1869ad5e-1959-446c-b2a8-3fcdf3e79667
Geraghty, Adam
2c6549fe-9868-4806-b65a-21881c1930af
Dawson, Sarah
1689f00c-c088-4e64-85f4-253e727b05ec
Kendrick, Tony
c697a72c-c698-469d-8ac2-f00df40583e5
Maund, Emma, Stuart, Beth, Moore, Michael, Dowrick, Christopher, Geraghty, Adam, Dawson, Sarah and Kendrick, Tony
(2019)
Managing antidepressant discontinuation: a systematic review.
Annals of Family Medicine, 17 (1), .
(doi:10.1370/afm.2336).
Abstract
Purpose
To determine the effectiveness of interventions to manage antidepressant discontinuation, and outcomes for patients.
Methods
Systematic review with narrative synthesis and meta-analysis. Sources: MEDLINE, PubMed, Embase, PsycINFO, AMED, Health Management Information Consortium (HMIC), OpenGrey, and WHO International Clinical Trials Registry Platform (ICTRP) to March 2017. Including: randomised controlled trials (RCTs), quasi-experimental, and observational studies assessing interventions to facilitate discontinuation of antidepressants for depression in adults. Primary outcomes: antidepressant discontinuation, and discontinuation symptoms. Secondary outcomes: relapse/ recurrence, quality of life, antidepressant reduction, sexual, social, and occupational function.
Results
Of 15 studies included, 12 were in the synthesis (8 RCTs, 2 single-arm trials, 2 retrospective cohort studies). None of the studies was rated high risk for selection or detection bias. Two studies prompting primary care provider (PCP) discontinuation with antidepressant tapering guidance found 6% and 7% of patients discontinued, versus 8% for usual care. Six studies of psychological or psychiatric treatment plus tapering reported cessation rates of between 40% and 95%. Two studies reported a higher risk of discontinuation symptoms with abrupt termination. At 2 years, risk of relapse/ recurrence was lower with cognitive behaviour therapy (CBT) plus taper versus clinical
management plus taper (15%-25% vs 35%-80%: RR 0.34, 95% CI 0.18 to 0.67; 2 studies).
Relapse/recurrence rates were similar for mindfulness based cognitive therapy (MBCT) with tapering and maintenance antidepressants (44%-48% vs 47%-60%; 2 studies).
Conclusions
CBT or MBCT can help patients discontinue antidepressants without increasing the risks of relapse/recurrence, but are resource intensive. More scalable interventions are needed, incorporating psychological support.
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Maund 2019 Managing antidepressant discontinuation
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More information
Accepted/In Press date: 1 November 2018
e-pub ahead of print date: 1 January 2019
Published date: January 2019
Keywords:
Antidepressants, prescribing, PRIMARY CARE
Identifiers
Local EPrints ID: 428015
URI: http://eprints.soton.ac.uk/id/eprint/428015
ISSN: 1544-1709
PURE UUID: 988b2990-b0b0-4e9f-812c-043c82cab8c4
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Date deposited: 06 Feb 2019 17:30
Last modified: 16 Mar 2024 04:28
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Contributors
Author:
Christopher Dowrick
Author:
Sarah Dawson
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