Recent guidelines suggest that the overall quantity and duration of antidepressant prescriptions should be reduced. In this paper, we comment on the evidence both for and against this view.
Methods
We critically review the arguments proposed by proponents of antidepressant deprescribing in the context of the evidence-base for the treatment of depression.
Results
Proponents of deprescribing do not address the substantive issues of whether inappropriate prescribing has been demonstrated, and when prescribing is needed. Their arguments for deprescribing are rebutted in this context.
Conclusions
Whether or not to deprescribe antidepressant medication needs to take into consideration the risk-benefit profile of the decision, the responsibility for which needs to be shared and based on the context of the patient’s depression, their preferences, experiences and perspectives.
DaviesJReadJKrugerD, et al.Politicians, experts, and patient representatives call for the UK government to reverse the rate of antidepressant prescribing. BMJ2023; 383: 2730. DOI: 10.1136/bmj.p2730.
2.
HorowitzMTaylorDM. The Maudsley deprescribing guidelines: antidepressants, Benzodiazepines, Gabapentinoids and Z-drugs. Hoboken, NJ, USA: Wiley Blackwell, 2024, p. 592.
3.
MalhiGSBellEBassettD, et al.The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. Aust N Z J Psychiatry2021; 55: 7–117. DOI: 10.1177/0004867420979353.
JormAF. Australia’s ‘Better Access’ scheme: has it had an impact on population mental health?Aust N Z J Psychiatry2018; 52: 1057–1062. DOI: 10.1177/0004867418804066.
10.
CiprianiAFurukawaTASalantiG, et al.Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. Lancet2018; 391: 1357–1366. DOI: 10.1016/S0140-6736(17)32802-7.
11.
LeuchtSHierlSKisslingW, et al.Putting the efficacy of psychiatric and general medicine medication into perspective: review of meta-analyses. Br J Psychiatry2012; 200: 97–106. DOI: 10.1192/bjp.bp.111.096594.
12.
CouplandCDhimanPMorrissR, et al.Antidepressant use and risk of adverse outcomes in older people: population based cohort study. BMJ2011; 343: d4551. DOI: 10.1136/bmj.d4551.
13.
DuffyLClarkeCSLewisG, et al.Antidepressant medication to prevent depression relapse in primary care: the ANTLER RCT. Health Technol Assess2021; 25: 1–62. DOI: 10.3310/hta25690.
14.
LewisGMarstonLDuffyL, et al.Maintenance or discontinuation of antidepressants in primary care. N Engl J Med2021; 385: 1257–1267. DOI: 10.1056/NEJMoa2106356.
15.
ClarkeCSDuffyLLewisG, et al.Cost-utility analysis of discontinuing antidepressants in england primary care patients compared with long-term maintenance: the ANTLER study. Appl Health Econ Health Policy2022; 20: 269–282. DOI: 10.1007/s40258-021-00693-x.
BeshearsJChoiJJLaibsonD, et al.How are preferences revealed?J Public Econ2008; 92: 1787–1794. DOI: 10.1016/j.jpubeco.2008.04.010.
18.
LaljiHMMcGroganABaileySJ. An analysis of antidepressant prescribing trends in England 2015–2019. J Affect Disord Rep2021; 6: 100205. DOI: 10.1016/j.jadr.2021.100205.
19.
CruickshankGMacgillivraySBruceD, et al.Cross-sectional survey of patients in receipt of long-term repeat prescriptions for antidepressant drugs in primary care. Ment Health Fam Med2008; 5: 105–109.
20.
AmbresinGPalmerVDensleyK, et al.What factors influence long-term antidepressant use in primary care? Findings from the Australian diamond cohort study. J Affect Disord2015; 176: 125–132. DOI: 10.1016/j.jad.2015.01.055.
21.
EveleighRGruttersJMuskensE, et al.Cost-utility analysis of a treatment advice to discontinue inappropriate long-term antidepressant use in primary care. Fam Pract2014; 31: 578–584. DOI: 10.1093/fampra/cmu043.
22.
PurtleJNelsonKLCountsNZ, et al.Population-based approaches to mental health: history, strategies, and evidence. Annu Rev Publ Health2020; 41: 201–221. DOI: 10.1146/annurev-publhealth-040119-094247.
23.
DaviesJReadJ. A systematic review into the incidence, severity and duration of antidepressant withdrawal effects: are guidelines evidence-based?Addict Behav2019; 97: 111–121. DOI: 10.1016/j.addbeh.2018.08.027.
24.
JauharSHayesJ. The war on antidepressants: what we can, and can't conclude, from the systematic review of antidepressant withdrawal effects by Davies and Read. Addict Behav2019; 97: 122–125. DOI: 10.1016/j.addbeh.2019.01.025.
25.
JacksonHJHaslamN. Ill-defined: concepts of mental health and illness are becoming broader, looser, and more benign. Australas Psychiatr2022; 30: 490–493. DOI: 10.1177/10398562221077898.
26.
O’MahonyDCherubiniAGuiterasAR, et al.STOPP/START criteria for potentially inappropriate prescribing in older people: version 3. Eur Geriatr Med2023; 14: 625–632. DOI: 10.1007/s41999-023-00777-y.
