Long-term use of antipsychotics and antidepressants is not evidence-based

Interventions to help patients withdraw from depression drugs: A systematic review

BACKGROUND

Depression drugs can be difficult to come off due to withdrawal symptoms. Gradual tapering with tapering support is needed to help patients withdraw safely.

OBJECTIVE

To review the withdrawal success rates, using any intervention, and the effects on relapse/recurrence rates, symptom severity, quality of life, and withdrawal symptoms.

METHODS

Systematic review based on PubMed and Embase searches (last search 4 October 2022) of randomised trials with one or more treatment arms aimed at helping patients withdraw from a depression drug, regardless of indication for treatment. We calculated the mean and median success rates and the risk difference of depressive relapse when discontinuing or continuing depression drugs.

RESULTS

We included 13 studies (2085 participants). Three compared two withdrawal interventions and ten compared drug discontinuation vs. continuation. The success rates varied hugely between the trials (9% to 80%), with a weighted mean of 47% (95% confidence interval 38% to 57%) and a median of 50% (interquartile range 29% to 65%). A meta-regression showed that the length of taper was highly predictive for the risk of relapse (P = 0.00001). All the studies we reviewed confounded withdrawal symptoms with relapse; did not use hyperbolic tapering; withdrew the depression drug too fast; and stopped it entirely when receptor occupancy was still high.

CONCLUSION

The true proportion of patients on depression drugs who can stop safely without relapse is likely considerably higher than the 50% we found.

Why it’s time to stop saying “mental illness”: A commentary on the revision of the Irish Mental Health Act

The Irish Mental Health Act (2001) is undergoing revision.  In 2014 an Expert Review Group recommended that the term currently used in the act “mental disorder”, should be replaced with the term “mental illness”.  We argue that the proposed change, while well intentioned, contradicts the internationally adopted terminology of “mental disorder” used by the United Nations, World Health Organisation and European Commission. The term “mental illness” is atavistic, it implies an unsupported cause, it contravenes the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD), and it is associated with concerns regarding stigma and reduced self-efficacy.  Furthermore, the term “mental illness” is not used in any internationally accepted diagnostic or classification system in the mental health field. While any term used to describe mental health problems, may be contested, Ireland should not revert to using archaic terminology.  In accordance with international best practice, and perhaps in lieu of a willingness to accept more progressive alternatives, Ireland should continue to use cause-neutral terminology, such as “mental disorder”, in the revised Mental Health Act.