Depression is a leading cause of illness and death worldwide. Short-term and medium-term therapy with antidepressants (usually four to six months) is often effective in alleviating depressive symptoms; however the long-term nature of many depressive disorders and the risk of many people to relapse after treatment begs the question: how long should antidepressants be taken?
John Geddes and colleagues from the University of Oxford, UK, pooled data from 31 randomised trials which included around 4400 patients. All participants in the trials had already received treatment for acute depressive disorders and were randomised to receive continuous treatment with antidepressants or placebo.
Treatment for one or two years with antidepressants substantially reduced the likelihood of relapse compared with those who discontinued active treatment. The average rate of relapse on placebo was around double that of treatment-41% compared with 18%. The proportional reduction in risk of depressive relapse was generally independent of the underlying risk of relapse, the duration of treatment before randomisation, or the duration of short-term and medium-term therapy.
Co-author Guy Goodwin comments: "Few other interventions in psychiatry are supported by such robust findings, based on more than 4000 patients in randomised trials. We know that many patients remain at appreciable risk of recurrence after 4-6 months of treatment with antidepressants, and another one or two years of continuation treatment will approximately halve their risk of another episode. In other words, the positive benefits of antidepressants do not wear off over time. Many patients who do exceptionally well may elect to take such medicines indefinitely rather than increase the risk of further illnesses by stopping. "
Contact: University of Oxford Press Office, Wellington Square, Oxford OX1 2JD, UK; T) +44 (0)1865 280528; F) +44 (0)1865 280535; E) press.office@admin.ox.ac.uk
(from 24.02.2003) Dr John R Geddes,Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX; T) +44 (0)1865 226480; F) +44 (0)1865 793 101; E) john.geddes@psychiatry.oxford.ac.uk
The Lancet