Successful dispensation of antidepressants with psychotherapy

Of the 1 million Dutch people who take antidepressants, an estimated 150,000 take them for a long time to prevent a relapse into depression. However, many would like to phase out its use. New research shows that short-term psychological interventions such as preventive cognitive therapy and mindfulness-based cognitive therapy provide demonstrable protection against recidivism, even if patients gradually reduce antidepressant use.

Relapse prevention

This relates to research conducted by Prof. Dr. Claudie Buckting and by Dr. Josephine Breedfelt, both affiliated with the Amsterdam UMC. They were studying recently Published in JAMA Psychiatry. The researchers compared continued use of antidepressants with antidepressant withdrawal while patients received psychological intervention specifically aimed at preventing relapse. They used all individual patient data from four previously published randomized controlled trials (n = 714) in the meta-analysis. They found no difference in relapse risk between the two conditions over 15 months of follow-up.

Incidentally, the results aren’t entirely new; The results of the meta-analysis are largely consistent with previous research that has also shown the benefit of combining psychotherapy with gradual flow, but in those studies it was only possible to make statements about who works best to a limited extent.

common approach

Josephine Breedfelt says the latter is now more visible. The protective effect of the combination approach does not appear to depend on particular characteristics of patients, such as age or number of previous depressive episodes. Breedvelt: While clinical guidelines recommend long-term use of antidepressants in high-risk patients. It’s true that patients who were younger when they first became depressed, who have many residual symptoms or who have only recently recovered, are at a higher risk of relapse, but if you then look at the type of interventions, the risk of relapse is not. Appear. It is higher if they cut back on their antidepressants and receive psychotherapy or continue to use antidepressants.

An important side note: This always concerns people who recover reasonably well after depression, while previous research has shown that 30 percent have “partially recovered,” meaning they still have residual complaints. The question is how will you then deal with these people? We at AMC are looking for the right approach. In the meantime, we’ll start a “recovery clinic” for this patient group next week.

tapered strips

In the Netherlands, expert expert/researcher Peter Groot and Professor of Psychiatry Jim van Os have been stressing the importance of tapering with tapering for some time now. They argue for its application and compensation. At the same time, ZonMw recently made available €1.5 million for research into the efficacy of tapering, and more specifically two methods of tapering: the usual versus slower tapering – that is, tapering in smaller doses over a longer method – of paroxetine. . Breedvelt acknowledges that the pace of phase-out is a point of interest. It is true that sometimes tapering happens too quickly or too suddenly. Safe reduction should be done slowly and in consultation between physician and patient.

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In the meantime, she believes that the results of the meta-analysis will influence national and international guidelines on treating patients. Because, according to Breedfelt, the point is that clinicians and patients with recurrent depression who want to reduce antidepressant use now have more options: “Our results help with joint decision making.”

Watch an interview with the researchers here:

https://edhub.ama-assn.org/jn-learning/audio-player/18612517

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