Early termination of antidepressant drug treatment

Guidelines for antidepressant drug therapy recommend continuing treatment f or several months, even after recovery. Premature termination of medication is viewed as a significant reason for chronicity in depressive disorders. To study the scope and type of this problem, routine treatment cases must b e observed in sufficient numbers. In four subsequent drug utilization obser vation studies, the time course and reasons for early termination (i.e., du ring the first weeks of fluoxetine treatment for depression) were investiga ted in (1) 15,601 patients of 4,696 general practitioners; (2) 2,401 patien ts of all ages treated by 479 neuropsychiatrists from 1990 to 1991; (3) 757 patients of all ages treated by 213 neuropsychiatrists from 1992 to 1993; and (4) in 977 geriatric subjects treated by 216 neuropsychiatrists. In stu dy 1, treatment was terminated during the first 10 weeks in 32.9% of cases; in study 2, in 48.0%; in study C, in 31.2%; and in study D, in 31.0%. When treatment was discontinued because of adverse events, the median of treatm ent duration was approximately 15 days; in cases of clinical deterioration, 20 days; in cases of poor response, 40 days; and when the reason was good response, the median of treatment duration was approximately 43 days. This is the largest field study on early termination of antidepressant treatment available to date. The consistency of results, which were collected from a large number of patients of different ages and from specialists as well as general practitioners, speaks for the validity and stability of the observ ed phenomena. The different forms of early treatment termination are discus sed and addressed separately because they each have special risks and are d ifferently associated with treatment failure.