Consequences of Recurrence of Major Depressive Disorder: Is Stopping Effective Antidepressant Medications Ever Safe?

Abstract

According to the World Health Organization, major depressive disorder is the world's leading cause of disability. If clinical remission is not attained and sustained, episodes tend to recur with greater severity and with lessening responsivity to conventional treatments. Reasonably well-established clues and guidelines are presented about the high risk and profound consequences of recurrence of major depressive disorder if successful antidepressant treatments are discontinued. The authors describe actions required to achieve a "lifetime wellness" focus for treatment. Current approaches would need to be transformed from attainment of clinical remission to attainment and maintenance of lifetime wellness, with the knowledge that some individuals may need continuous treatment. Risk factors would need to be assessed and used to formulate clinical treatment guidelines for risk of recurrence. Clinical trials would need to be greatly lengthened. Measurement-based care and precision medicine would be the foundation for informing clinical decisions. The authors provide guidance in determining how to discontinue antidepressants if that decision is made despite risks.

Keywords: Antidepressants; Major depressive disorder.

FIGURE 1.

Longitudinal course of major depressive disorder, severity scores on the 17-item Hamilton Depression Rating Scale, and response terminology

FIGURE 2.

Factors suggesting higher risk of major depressive disorder (MDD) recurrence with treatment discontinuation

FIGURE 3.

Clinical guidelines informing antidepressant maintenance therapy^{a a}APA, American Psychiatric Association (11); CANMAT, Canadian Network for Mood and Anxiety Treatments (30); British Association for Psychopharmacology (32).