COMMENTARY

Concerns about the premature discontinuation of antidepressant treatment in primary care were first expressed 30 years ago.¹ In the absence of long term data from randomised trials, it has been assumed that early cessation of therapy contributes to the preventable morbidity associated with depression.² This landmark review by Geddes et al addresses one of the most important clinical dilemmas in the management of depression: how long should antidepressant treatment continue in order to minimise the risk of subsequent relapse?

We do not have a definitive answer to this question, primarily due to the limited data available, most of which come from studies conducted mainly in secondary care settings with patients at high risk of relapse. Despite the limitations inherent in meta-analysis (differences between studies in patients recruited, antidepressants used, length of antidepressant treatment before randomisation, and whether results are reported on an intention to treat basis), this review suggests that an additional year of antidepressant treatment is likely to reduce the risk of relapse by about half in people at high risk, irrespective of which class of antidepressant is used or the length of prior treatment.

For people at lower risk of relapse, the benefit of continuing treatment is less clear. In terms of secondary prevention, this is a key patient group. It is here that the best opportunities lie to prevent development of recurrent depression, where the burden of illness becomes particularly high. These patients tend to be managed in primary care settings. Although available data are fewer for this group, Geddes et al suggest that a continuation of therapy may still be beneficial, though there is a need for prospective randomised studies to confirm these tentative findings.