The REDUCE Trial is open access and can be read here.
The following comments have been published on the associated JAMA web-page and are shared below:
I have submitted the following response hoping that it will be published by JAMA Psychiatry:
Comment on: Internet and Telephone Support for Discontinuing Long-Term Antidepressants: The REDUCE Cluster Randomized Trial
Comment by Peter Scott-Gordon, 19 July 2024
Am I alone in feeling that I do not matter?
Following the publication of the REDUCE trial by Kendrick et al a number of clarifications and questions have been asked in relation to the study design, the conclusions made and the key messages that the study team have since helped disseminate to the general public.
Professor Kendrick has replied to some of these questions and stated on social media:
“Half of people relapse on stopping them. Half need them to stay well” [8 July 2024]
“The majority, 60% had recurrent depression” [July 2024]
The REDUCE trial studied people ‘coming off long-term treatment’.
I am now retired as a psychiatrist, but when I began in my training I was educated by the Defeat Depression Campaign. This campaign had several KEY messages:
[1] ‘Clinical depression’ [moderate to severe] was significantly under-treated.
[2] Routinely cited a prevalence of clinically treatable depression as 1 in 20
[3] Unequivocally stated “Patients should be informed clearly when antidepressants are first prescribed that discontinuing treatment in due course will not be a problem”
In terms of current rates of prescribing of antidepressants this context cannot be ignored. To do so would be both unscientific and unethical.
In Scotland, nearly 1 in 4 of the adult population is taking an antidepressant and a majority are taking them long-term. My understanding is that the figures for prescribing of antidepressants in England and Wales are slightly lower, but not by much.
I am neither an expert in statistical analysis nor in research/trials. However, there is a most glaring numerical difference in figures three decades apart: from a stated prevalence of treatable depression of 1 in 20 in the 1990s to 1 in 4 adults taking antidepressants in the 2020s. Even taking into account the use of antidepressants for other conditions, the figures do not add up. If I understand correctly, Professor Kendrick, lead author of the REDUCE trial is stating that 60% of those who are today taking antidepressants have recurrent depression and require long-term antidepressants to “stay well”. Once again, this is well beyond the 1 in 20 prevalence figure on which the 1990s Defeat Depression Campaign was based.
It is disappointing that the studies [REDUCE and ANTLER] have failed to adequately distinguish withdrawal symptoms from relapse, as physiological dependence on antidepressants may be a more plausible reason for the rise in prescribing rather than that such a high proportion of the population now suffers from clinical depression.
Those living with ongoing harm related to medicines taken as prescribed deserve, at the very least, to be recognised.