Dissipation of dark clouds, renewed energy, revived will: so many benefits described by people suffering from depression and for whom antidepressants have been synonymous with regained life. As a reminder, these treatments are mainly recommended in cases of moderate to severe depression (read framed), ideally in combination with psychotherapy. “For mild depression, the recommendations are rather in the direction of regular medical monitoring – very often provided by the general practitioner – and psychotherapy”, specifies Dr. Vasiliki Galani, head of clinic at the Liaison Psychiatry Service and crisis intervention of the University Hospitals of Geneva (HUG). When treatment with an antidepressant is required, the optimal duration varies according to the case: six to nine months for a first depressive episode, a minimum of two years if it is a second episode and even more if it is this is a third. Why such recommendations? “The treatment strategy is based on two phases, explains the expert. The first consists in treating the acute phase of the depression, the second, in consolidating the state of health and preventing relapse”, indicates the specialist. Hence the dizziness that stopping treatment can represent and the interest of a study like the one published in the prestigious New England of medicine*.
56% relapse
The objective of this research, conducted in the United Kingdom: to compare, within the framework of a randomized double-blind trial, two groups of patients suffering from depression, some maintaining their treatment, the other seeing it reduced, then replaced ( without knowing it) by a placebo. Common point of the 478 volunteers involved: all had experienced at least two depressive episodes or had been taking antidepressants for at least two years. Results at the end of the 52 weeks of study? A higher relapse rate in patients belonging to the treatment discontinuation group compared to the others, the percentages being respectively 56 and 39%. Patients who had their treatment interrupted also showed more symptoms of anxiety and withdrawal.
Gradual reduction and regular medical follow-up
What to deduce? “These results confirm an inescapable aspect of depression, its recurrent nature,” underlines Dr. Galani. For a first episode, the risk of relapse is estimated at between 50 and 60%; for a second, 70% and almost 90% for a third.” And to detail, about the study: “One of its strengths is to have favored people who have experienced several recurrences, the results are thus linked to the reality of this pathology. It is a pity, on the other hand, that the authors do not give indications on the possible psychological accompaniment of the volunteers, nor on their physical or psychic comorbidities. Still, this study reminds us of the importance of the precautions to be taken before stopping treatment with antidepressants.”
mindfulness meditation
Experts are unanimous on the importance of a gradual reduction in treatment and regular medical monitoring. And all the more so – this recent study confirms this – as it is currently impossible to identify in advance the patients who will experience a relapse. Another possible ally: mindfulness meditation. “More and more studies confirm the benefits of this practice for the prevention of depression relapses,” continues Dr. Galani. Mindfulness meditation aims – among other things – to soothe ruminations and anchor oneself in the present moment. Simple and demanding at the same time, its effectiveness is based above all on the regularity of its practice, ideally on a daily basis.
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*Lewis G, et al. Maintenance or Discontinuation of Antidepressants in Primary Care. N Engl J Med. 2021 Sep 30;385(14):1257-1267.
Published in Le Matin Dimanche on 05/29/2022
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Antidepressants: for a time or for life?
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