Cognitive behavioral therapy and mindfulness-based cognitive therapy helped patients discontinue their antidepressant regimen without increased risk for recurrence or relapse, according to a systematic review recently published in Annals of Family Medicine.
“Although some people need antidepressants to prevent relapse/recurrence, 30% to 50% of long-term users have no evidence-based indication to continue their medication,” Emma Maund, MSc, MPhil, PhD, of Primary Care and Population Sciences at the University of Southampton in England, and colleagues wrote.
Researchers reviewed 15 studies that monitored interventions designed to cease antidepressant uselasting anywhere from 20 weeks to 6 months.
They found the risk for recurrence/relapse was lower with CBT plus taper when compared to clinical management plus taper at 2 years (RR = 0.34; 95% CI, 0.18-0.67). There was no difference in recurrence between mindfulness-based cognitive therapy with tapering and maintenance antidepressants at 15 months (RR = 0.9; 95% CI, 0.75-1.07).
Mindful of limited appointment windows primary care physicians often have with their patients, study co-author Tony Kendrick, MD, FRCGP, FRCPsych (Hon), FHEA, said PCPs can help patients by connecting them with resources.
“We are not suggesting PCPs and family medicine doctors provide CBT or mindfulness-based cognitive therapy themselves. Refer the patient to a psychologist or arrange for online CBT,” he told Healio Primary Care Today.
Kendrick also offered some clinical pearls that PCPs can share with their patients who choose to utilize these nonpharmaceutical options to manage their depression.
“Warn these patients ahead of time that about half of patients undergoing CBT or mindfulness-based therapy may experience withdrawal symptoms. These symptoms are usually short-lived and about 20% to 25% of patients have a relapse of depression. The depression symptoms that cannot be resolved in a short amount of time can be treated again, as these patients are still being monitored for relapse while tapering their antidepressant medication,” Kendrick said in the interview. – by Janel Miller
Disclosure s : Maund and Kendrick report receiving funding from the National Institute for Health Research for the REDUCE (REviewing long term anti-DEpressant Use by Careful monitoring in Everyday practice) applied health research program 2016-2022). Please see the study for all other authors’ relevant financial disclosures.