Antidepressants: temporary or for life?

Clearing of dark clouds, renewed energy, revived will: so many benefits are described by people suffering from depression for whom antidepressants are synonymous with regained life. As a reminder, these treatments are mainly recommended for moderate to severe depression (read framed), ideally in combination with psychotherapy. “In the case of mild depression, the recommendations are more in the direction of regular medical monitoring – very often by the general practitioner – and psychotherapy,” specifies Dr. Vasiliki Galani, Head of Clinic at the Liaison Psychiatry Service and Crisis Intervention at the University Hospitals of Geneva (HUG). When antidepressant treatment is required, the optimal duration varies from case to case: six to nine months for a first depressive episode, at least two years for a second episode, and even longer for a third. Why such recommendations? “The treatment strategy is based on two phases,” explains the expert. The first serves to treat the acute phase of depression, the second to consolidate the state of health and prevent relapses,” says the specialist. Hence the dizziness that stopping treatment can represent and the interest in a study like the one published in the prestigious journal New England of Medicine*.

56% relapse

The aim of this research, carried out in the United Kingdom: to compare, within the framework of a double-blind, randomized study, two groups of patients suffering from depression, some of whom continue their treatment, the other sees it reduced and then replaced (without knowing it) with a Placebo. What the 478 volunteers had in common: 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 rate of recurrence in patients belonging to the dropout group compared to the others, with percentages being 56% and 39%, respectively. Patients whose treatment was interrupted also showed more anxiety and withdrawal symptoms.

Gradual reduction and regular medical follow-up

What is to be derived? “These results confirm an unavoidable aspect of depression, its recurrent nature,” emphasizes Dr. Galani. For a first episode, the risk of recurrence is estimated at 50-60%; for a second 70% and almost 90% for a third.” And in detail about the study: “One of its strengths is to have favored people who have experienced several relapses, the results are thus linked to the reality of this pathology. On the other hand, it is a pity that the authors do not give any indication of any possible psychological support for the test subjects, or of their physical or psychological comorbidities. Nonetheless, this study reminds us of the importance of precautions to take before stopping antidepressant treatment.”

mindfulness meditation

Experts agree that a gradual reduction in treatment and regular medical monitoring are important. And all the more so – this recent study confirms it – since it is currently impossible to identify in advance the patients who will relapse. Another possible ally: mindfulness meditation. “More and more studies are confirming the benefits of this practice in preventing flare-ups of depression,” continues Dr. Galani gone. One of the goals of mindfulness meditation is to calm ruminations and anchor yourself in the present moment. Simple and sophisticated at the same time, its effectiveness is based above all on the regularity of its practice, ideally on a daily basis.

What if it was depression?

Insomnia, tiredness, headaches and back pain, indigestion, irritability or even difficulty concentrating: the symptoms of depression can be as varied as they are misleading and lead to somatic rather than mental disorders. To diagnose and assess the severity of depression, physicians rely on two internationally recognized classifications in particular: the Diagnostic and Statistical Manual of Mental Illnesses, 5the Version (DSM-V) and the International Classification of Diseases, 10e Version (ICD-10). Also scientifically validated, two questions prove to be valuable allies in prevention. Here you are.

In the last two weeks:

1. Have you felt down, depressed, or hopeless all day, almost every day?

2. Have you lost interest or enjoyment in your activities throughout the day, most days?

A positive answer to these two questions is almost 70% characteristic of depression.

Did you say “antidepressants”?

Not always easy to navigate as the antidepressant family is huge. First Element: Most antidepressants prescribed today are designed to “2e Generation”.

Selective serotonin reuptake inhibitors (SSRIs), selective serotonin/norepinephrine reuptake inhibitors (ISRN), or selective norepinephrine and dopamine reuptake inhibitors (IRND): Behind these convoluted names one can guess the effect of these treatments on the neurotransmitters that act in our brain . Note that antidepressants may also be prescribed for anxiety disorders, mood disorders, and certain pain syndromes.

While the effectiveness of these treatments is the same, their biggest difference is their side effects. Therefore, when choosing the antidepressant, it is important to take into account the patient’s profile, their symptoms and their comorbidities (presence of other physical or psychological pathologies). To date, the most popular molecules, because they are best tolerated, are sertraline and escitalopram, followed by venlafaxine and mirtazapine.

The first-generation antidepressants still on the market—tricyclics (TCAs) and monoamine oxidase inhibitors (MAOIs)—are being prescribed less and less because of their numerous side effects. They are particularly indicated in the event of therapy failure with other possible treatments.

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*Lewis G., et al. Maintenance or discontinuation of antidepressants in primary care. N Engl J Med 30 Sep 2021;385(14):1257-1267.

Published in Le Matin Dimanche on 05/29/2022


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