A tremendous research effort has gone into better understanding whether or not a particular patient will respond to a particular antidepressant, and predicting response versus non-response to antidepressant medication. Yet, it seems to me, that we have forgotten those people, who after years of use, would like to see what life is like off antidepressants.
When people go off antidepressants - even under medical supervision - it is hard to stay off them. Take for example the rather disturbing documentary, Numb. You can view this online here: http://www.numbdocumentary.com/Numb_Documentary/Watch.html
The typical professional opinion on this failure to stay off an antidepressant is this: "The mood and anxiety disorders are commonly reoccurring disorders. Thus, what you are seeing is a return of the disorder, not withdrawal." In contrast, however, there is good research to show that as we age people are more emotionally resilient.
How can we better research this topic and avoid the many confounding factors that researchers would inevitably have to consider.
Know of any good research that has been done on this topic? Post it here. Interested in initiating further discussions? I'm all ears.
I truly believe this is a research topic of huge importance.
According with WHO maintenance treatment is sometimes continued for years without the person being re-evaluated and thus, in some instances, without benefit. This is inconsistent with the preference of only medicating where there is need and clinical
oversight. However WHO gives STRONG recommendation to adult individuals with depressive episode/disorders who have benefited from initial antidepressant treatment, that antidepressant treatment should not be stopped before 9 -12 months after recovery and that treatment should be regularly monitored in which frequency of contact should be determined by the adherence, severity and by local feasibility issues.
Withdrawal studies are used to assess long-term antidepressant efficacy. People who respond to an antidepressant are then randomized to either continue the antidepressant or switch (usually abruptly) to placebo. Discontinuation effects would lead to worse outcomes for those switched to placebo - these are interpreted as a sign that the drug is effective in the long-term. This makes no sense. It is quite difficult to sort out whether the superior results for patients who remain on antidepressants (relative to those switched to placebo) are due to truly superior efficacy or to simply avoiding withdrawal effects by staying on the medication.
A good reference on this is:
El-Mallakh RS, Briscoe B. 2012. Studies of long-term use of antidepressants: How should the data from them be interpreted? CNS Drugs 26:97–109
During 35 y. treating depression, I never encountered any weaning syndrome, especially when switching for an other medication.
Stopping drug(s) when equilibration is good has usually no short term effect. If total treatment time has been too short, recurrence occurs after a variable time, from some weeks to months.
If equilibration is sub-optimal, worsening occurs usually after a few days.
bmaroy.free.fr/depressionF&E
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