Long-term treatment of depression with antidepressants benefits many patients by (1) reducing the likelihood of relapse or recurrence and (2) increasing the amount of time spent asymptomatic between episodes.3-5
Discontinuing antidepressant treatment in the acute phase before full symptomatic remission increases the likelihood of relapse of the original episode,6 and discontinuing treatment during the continuation phase after symptomatic remission has also been associated with an increased risk of relapse.7 Frequently, when a successful antidepressant treatment is discontinued, after a variable length of time spent in recovery, another depressive episode develops (i.e., recurrence occurs).8
References:
1. Eaton WW, Shao H, Nestadt G, et al. Population-based study of first onset and chronicity in major depressive disorder. Arch Gen Psychiatry 2008; 65 (5): 513–520.
2. Solomon DA, Keller MB, Leon AC, et al. Multiple recurrences of major depressive disorder. Am J Psychiatry 2000; 157 (2): 229–233.
3. Kishi T, Sakuma K, Hatano M, et al. Relapse and its modifiers in major depressive disorder after antidepressant discontinuation: meta-analysis and meta-regression. Mol Psychiatry 2023; 28 (3): 974–976.
4. Lewis G, Marston L, Duffy L, et al. Maintenance or discontinuation of antidepressants in primary care. N Engl J Med 2021; 385 (14): 1257–1267.
5. Sim K, Lau WK, Sim J, et al. Prevention of relapse and recurrence in adults with major depressive disorder: systematic review and meta-analysis of controlled trials. Int J Neuropsychopharmacol 2015; 19 (2): pyv076.
6. Shelton RC. Steps following attainment of remission: discontinuation of antidepressant therapy. Prim Care Comp J Clin Psychiatry 2001; 3 (4): 168–174.
7. Kato M, Hori H, Inoue T, et al. Discontinuation of antidepressants after remission with antidepressant medication in major depressive disorder: a systematic review and meta-analysis. Mol Psychiatry 2021; 26 (1): 118–133.
8. Severe J, Greden JF, Reddy P. Consequences of recurrence of major depressive disorder: is stopping effective antidepressant medications ever safe? Focus 2020; 18 (2): 120–128.
