The REDUCE Trial is open access and can be read here.
I submitted the following response hoping that it would 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” [8 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 physical 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.
JAMA NETWORK OPEN responded:
I had carefully read the commenting policy for JAMA NETWORK OPEN and thought that I had carefully and fully considered the policy in writing my reply. The policy makes clear: ‘We do not publish every submitted comment. We may reject comments because they’:
I am one of the 60% of people taking an antidepressant long-term that the REDUCE trial established are unable to stop an antidepressant. Nearly 1 in 4 adults Scots are taking antidepressants. A significant proportion of this [massive] group will have taken antidepressants longer than evidence based recommendations. Scottish Government ISD figures confirm, that year after year long-term prescribing of antidepressants continues to rise. This is not artifact. It is staring-you-in-the-face evidence.
Prior to the REDUCE study, stretching back at least two decades, other large studies have had the opportunity using scientific method, to try and understand why prescribing of antidepressants has become almost routinely long-term [here I refer to the MOORE Study, GEDDES Study, Star-D study, ANTLER study]. A further study, the SUSANA Survey, also had such an opportunity. The open question that requires to be asked is: why these studies have missed opportunities to systematically, openly and logically address one of the potential reasons for increased prescribing of antidepressants long-term? That being physical dependence on prescribed antidepressants [or in other words lasting changes ‘adaptations’ in the billions of neurons that each of us have widely distributed throughout our body, and not just in our brain].
Instead of openly looking at this, academia and psychiatry have responded defensively and sometimes gone as far as to name call using denigratory labels applied sweepingly. This is stigma. Iatrogenic stigma.
The ‘mainstream’ response is generally that those who struggle to stop antidepressants either:
[1] have “relapsed” and require to take antidepressants long-term to “stay well”
[2] lack the “will” to stop [please note a range of words have been used but all suggest a lack of will]
As far as I am aware, there is no robust research to support either argument [1] or argument [2].
I wish to keep this short and direct. Something is going on here. Am I alone in feeling that I do not matter? Who cares? Who is listening? Does it matter if at least 60% of us are REDUCED?
