Withdrawal of unnecessary antidepressant medication: a randomised controlled trial in primary care

Abstract

Background: Antidepressant use has increased exponentially in recent decades, mostly due to long continuation. Aim: To assess the effectiveness of a tailored recommendation to withdraw antidepressant treatment. Design & setting: Randomised controlled trial in primary care (PANDA study) in the Netherlands Method: Long-term antidepressant users (≥9 months) were selected from GPs prescription databases. Patients were diagnosed with the Composite International Diagnostic Interview (CIDI). Long-term users without indication for maintenance treatment (overtreatment) were selected. The intervention consisted of disclosure of the current psychiatric diagnosis combined with a tailored treatment recommendation. Patients were followed for 12 months. Results: The study included 146 participants from 45 family practices. Of the 70 patients in the intervention group, 34 (49%) did not comply with the advice to stop their antidepressant medication. Of the 36 (51%) patients who agreed to try, only 4 (6%) succeeded. These figures were consistent with the control group, where 6 (8%) of the 76 patients discontinued antidepressant use successfully. Patients who were recommended to discontinue their antidepressant medication reported a higher relapse rate than the control group (26% versus 13%, P = 0.05). Conclusion: Changing inappropriate long-term antidepressant use is difficult.

Keywords

• antidepressant agents
• primary care
• depressive disorder
• anxiety disorder
• general practice
• inappropriate prescribing