Dear Dr Enric Aragonès,

The antidepressants have many indications beyond depression - panic disorder, chronic pain, social phobia, and some others. It is also very useful as a prevention of depressive episodes relapses and recurrence. Each case should be carefully studied by the physician and the patient considering risks and benefits. We should also consider the withdrawal symptoms of a fast interruption of the antidepressants. These papers below could be useful for tapering out antidepressants:

Balon R, Silberman EK, Starcevic V, et al. Benzodiazepines, antidepressants and addiction: A plea for conceptual rigor and consistency. J Psychopharmacol. 2019;33(11):1467-1470. doi:10.1177/0269881119878171

Freire RC, Amrein R, Mochcovitch MD, et al. A 6-Year Posttreatment Follow-up of Panic Disorder Patients: Treatment With Clonazepam Predicts Lower Recurrence Than Treatment With Paroxetine. J Clin Psychopharmacol. 2017;37(4):429-434. doi:10.1097/JCP.0000000000000740

Best regards,

Antonio

Currently, antidepressant treatment is carried out in the absence of an understanding of the cause of depression. Antidepressants try to treat the symptoms of depression. Antidepressants do not work on the underlying cause of depression. Currently, standardized antidepressant procedures do not address the underlying causes of depression. Antidepressant prescription and withdrawal procedures are not consistent with the mechanism of depression. Therefore, the appointment and withdrawal of antidepressants can be dangerous to the patient's health. It is necessary to adjust the procedures for the use of antidepressants in accordance with the mechanisms of the onset and development of depression, anxiety, panic, pain of unknown origin or phobia.

Hi

There are a few reasons where people may need chronic antidepressants.

Some people may have endogenous depression whereby they produce less neurotransmitter in their brain and thus have low mood. Some medical illnesses like hypothyroidism, Parkinson's disease, SLE, diabetes mellitus, epilepsy, left lobe tumors and pancreatic cancer can be associated with depression. This is biologically induced in the body and hence would constitute an organic mood disorder. Also chronic steroid administration can produce low mood.

If you want to withdraw the medication you would need to see if the stressful situation that induced the depressive episode in the first place still causes the patient to be unhappy or if the patient can accept the situation. If the patient can accept the problem or if the problem has remitted you can think about gradually withdrawing the medication over the period of a month or two months.

Guide lines for antidepressant treatment would be American Psychiatric Association guidelines or NICE guidelines.

Hope you find this useful.