Quentin Huys
Department of Psychiatry
UCL Max Planck Centre for Computational Psychiatry and Ageing Research
University College London
The burden of depression is to no small part due to its chronic or recurring
nature. As such, the maintenance of any treatment gains is of paramount
importance. A key step in this process is the decision to discontinue
antidepressant medication. However, at present there are no predictors to
indicate who can safely discontinue medication. The AIDA study recruited
123 patients who had remitted on antidepressant medication and were intent
on discontinuing their medication. Patients were randomized into two groups.
Both groups underwent two extensive assessments involving clinical,
behavioural, imaging and biochemical assessments, but one group was tested
before and after discontinuing antidepressants, while the other was tested
twice before discontinuation. Patients were followed up for 6 months to
monitor for relapses.
57 healthy, never-depressed matched controls were recruited. Of 104
patients who completed at least one assessment, 84 completed the study, with
34 relapsing during the follow-up. Amongst standard clinical variables, only
treatment by non-specialists was robustly associated with relapse (p=0.005),
but did not predict relapse out-of-sample. In contrast, several behavioural
(effort-related), psychological (brooding rumination, neuroticism) and
imaging (EEG alpha asymmetry) variables had predictive power (all p<.05),
while others were affected by discontinuation or distinguished remitted
patients from healthy controls. Relapse after antidepressant discontinuation
can be predicted by a number of variables. A combination of these may reach
an accuracy sufficient to guide clinical decision-making.