On the same antidepressant long-term, for two or more years

As already acknowledged, this is a growing population.^2,3 This group is less likely to have their antidepressant reviewed than people who have recently been initiated on treatment or are receiving a shorter course.^4,5 For some they may be ‘lost in the system’ and inadvertently continue treatment that is no longer needed.^14,22 For others their antidepressant treatment may be ineffective or causing adverse effects. Therefore, it is necessary to proactively review individuals’ progress, and while some guidelines provide clear advice regarding the frequency of review,^36,37,89  others remain vague.^20,50,90,91 For those with chronic illness, where long-term treatment is considered necessary, annual reviews may provide an optimal method e.g. assessing the need for TCA/duloxetine treatment of neuropathic pain from diabetes. 

For those under the care of specialist secondary care services (e.g. Pain Clinics, Alcohol and Drug Rehabilitation Services, Community Mental Health, Learning Difficulties, etc.), it is important that the specialist services update primary care prescribers about the appropriateness of continuing treatment. In some cases, this will facilitate the availability of prescribing information on the patient’s Emergency Care Summary.

Reviewing people receiving the same antidepressant for two or more years can result in one in four people having a change in treatment and some reducing and/or stopping their antidepressants.¹⁷