Four in ten Belgians on antidepressants for more than three years

Recent data from the Intermutualistic Agency (IMA), an organisation that compiles health insurance data in Belgium, has unveiled a concerning trend. In 2020, a staggering 74% of individuals taking antidepressants had been doing so for over a year.

The number marks a significant increase from 2010 when the figure stood at 68.4%. Moreover, the gender disparity in antidepressant use has also come to light, with women in Belgium nearly twice as likely to be prescribed antidepressants as men.

General practitioner and postdoctoral researcher Ellen Van Leeuwen, affiliated with Ghent University, sought more comprehensive figures from the IMA and discovered that roughly 40% of those taking antidepressants have been doing so for more than three years.

This statistic raises concerns, as the recommended guideline suggests that antidepressants should be prescribed for six to twelve months after symptom improvement, with the intent to eventually cease usage. In practice, however, antidepressants are often prescribed for significantly longer durations.

The National Institute for Health and Disability Insurance (NIHDI) data reveals that 73% of antidepressant prescriptions come from general practitioners. A prevailing fear of relapse, shared by both patients and doctors, plays a significant role in the prolonged use of these medications.

"For individuals who have experienced depression, the gravity of the condition is well understood, and they are often hesitant to discontinue treatment," Van Leeuwen told VRT. "Patients may be apprehensive about requesting a cessation of medication."

Furthermore, even general practitioners may be hesitant to reduce or discontinue antidepressant use, especially when they observe their patients' improved condition. While this reluctance is understandable, it remains essential for GPs to initiate conversations about tapering and discontinuation, particularly for stable patients who have been on the medication for an extended period.

Taking it easy

Gradually reducing antidepressant medication is crucial for a successful discontinuation, says Van Leeuwen. The conventional belief that two weeks are adequate for tapering has been replaced by the understanding that a minimum of four weeks, or even months, may be necessary.

Abruptly discontinuing antidepressants can result in withdrawal symptoms, including agitation, flu-like symptoms, nausea, sleep disturbances, and even a resurgence of depressive feelings. Van Leeuwen underscores the importance of recognizing these symptoms as a consequence of tapering too quickly, rather than an indicator that one cannot do without antidepressants.

She advises doctors to consider reinstating the original dosage and adopting a slower reduction process when faced with withdrawal symptoms. These symptoms are not indicative of a patient's inability to discontinue antidepressants, but rather a sign of the need for a more gradual approach.

Van Leeuwen highlights the significance of combining psychotherapy with medication, stating, "Everyone starting antidepressants should also receive psychotherapy, as it is in therapy that patients acquire coping strategies for challenging or stressful periods," she told VRT.

Ultimately, Van Leeuwen emphasises the importance of patients understanding that they are not alone in this journey, advocating for open communication with their doctors and seeking appropriate support. While some individuals may require more extensive support than others, she is optimistic that, for a significant portion of patients, discontinuing antidepressant medication is a feasible and achievable goal.

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