New research published today in JAMA Psychiatry shows that brief psychological interventions such as Preventive Cognitive Therapy (PCT) and Mindfulness-Based Cognitive Therapy (MBCT) can be an alternative to long-term antidepressant use. This research was led by Claudi Bockting, professor of clinical psychology in psychiatry and dr. Josefien Breedvelt, both from Amsterdam UMC with the international consortium relapse prevention ITFRA.

Record levels of people are taking antidepressants worldwide. A large amount of people take antidepressants to prevent relapse after recovery from depression. To date it is not yet known who can stop or continue antidepressant medication after recovery. Most often, patients at high risk of relapse continue to take antidepressants long-term to prevent a future relapse.

Two options

Clinicians and patients now have two options for preventing patients from relapse after recovery from depression. Either they continue to take antidepressant medication or a psychological intervention while patients taper or stop their antidepressant. The most researched interventions Preventive Cognitive Therapy (PCT) and Mindfulness-Based Cognitive Therapy (MBCT) consist of 8 sessions given over a period of 8 weeks. PCT focuses on examining thinking patterns, activating positive feelings and making a prevention plan. MBCT contains the use of meditation techniques.

What works for whom?

The withdrawal or tapering of antidepressants increases the risk of relapse, and not all patients want to take antidepressants long-term. However, current guidelines recommend that patients with a high risk of relapse should continue taking antidepressants on a long-term basis. At the moment, it is unclear to whom to recommend antidepressant continuation and who can taper or stop antidepressants. The central question the researchers studied was ‘is it possible to stop antidepressants, and for whom’?

Guidelines

This study, based on all individual participant data from RCTs on this comparison worldwide shows that psychological interventions can be an alternative to antidepressant continuation, even if a patient’s risk of relapse is high. That is, they have residual symptoms of depression or a high number of prior episodes. These findings are of importance for (inter)national clinical guidelines and for clinical practice for patients who wish to taper or stop their antidepressant. Bockting: "This is of great importance for the (inter) national guidelines for the treatment of people who take long-term antidepressants but have a strong desire to taper off."

Listen to the JAMA Network podcast with Claudi Bockting and Josefien Breedvelt.
Or read the publication in JAMA Psychiatry: Continuation of Antidepressants vs Sequential Psychological Interventions to Prevent Relapse in Depression