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Added Remote Support for Antidepressant Discontinuation Offers Only Small Benefits
Adding internet and phone support to a family practitioner review for possible discontinuation of long-term antidepressants provided small additional benefits, but the proportion of patients achieving discontinuation with and without remote support did not significantly differ. Researchers published their findings in JAMA Network Open.
“To our knowledge, this is the first study to demonstrate that facilitating discontinuation is possible at scale without providing resource-intensive psychological therapy,” wrote Tony Kendrick, MD, of the University of Southampton and the Aldermoor Health Centre, Southampton, England, and study coauthors.
The randomized trial investigated the safety and effectiveness of an added internet and phone support intervention compared with practitioner review alone. The study included 325 patients at low risk of relapse who were well enough to consider discontinuation and wished to do so. Among the patients, 178 were at intervention practices and 147 were at control practices.
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The support intervention proved noninferior for the primary safety outcome of depression at 6 months, according to the study. Scores on the 9-item Patient Health Questionnaire (PHQ-9) were slightly better with remote support after antidepressant discontinuation. A complete-case analysis showed a −1.1-point adjusted difference with the intervention. Patients in the intervention arm also had less severe withdrawal symptoms and better well-being compared with the control arm — differences researchers deemed “small but significant.”
The proportion of patients achieving antidepressant discontinuation by 6 months was 45.5% with internet and phone support and 41.9% without the added support, the study found. That difference was nonsignificant.
The rate of reported adverse events was approximately 15% in each arm.
“This cluster randomized clinical trial found that internet and telephone support did not significantly increase antidepressant discontinuation but provided small improvements in depression, antidepressant withdrawal symptoms, and mental well-being,” researchers wrote. “An active family practitioner review for possible discontinuation of inappropriate long-term antidepressant treatment proved to be safe and effective in both arms for more than 40% of patients willing to discontinue.”
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