Practice 10-Minute Consultation

Stopping antidepressants following depression

BMJ 2016; 352 doi: http://dx.doi.org/10.1136/bmj.i220 (Published 18 February 2016) Cite this as: BMJ 2016;352:i220
  1. Tamara Pringsheim, assistant professor1,
  2. Martina Kelly, associate professor2,
  3. Corrado Barbui, professor3
  1. 1Department of Clinical Neurosciences, Psychiatry and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
  2. 2Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
  3. 3Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy
  1. Correspondence to: T Pringsheim, Mathison Centre for Mental Health Research and Education, TRW Building, 3280 Hospital Drive NW, Calgary AB, T2N 4Z6, Canada tmprings{at}ucalgary.ca
  • Accepted 30 October 2015

What you need to know

  • After successful treatment and remission of depression with antidepressant medication, treatment should be continued for up to 12 months to reduce the risk of relapse

  • Treatment with antidepressants beyond a year after remission should be based on evaluation of risk factors for, and the potential consequences of, relapse. Individuals with two or more episodes of depression with significant functional impairment, residual depressive symptoms, functionally impairing physical health problems, or psychosocial difficulties are at higher risk of relapse

Jocelyn started taking citalopram one year ago for her first recorded episode of depression. Her symptoms improved six weeks later. Now that she feels well, she asks if she can stop taking the pills.

What you should cover

Explain to Jocelyn that, before making a decision about her medication, you should review her symptoms, response to treatment, and history of depression. Explain that there is guidance for doctors and patients on medication for depression, and a discussion to tailor that guidance to her case would be useful.

Review to what extent symptoms of depression persist (see box 1). For example, ask Jocelyn if she is enjoying life and if she is feeling confident? Use of structured tools such as the Patient Health Questionnaire-9 (PHQ9) can provide …

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