Plain English Summary
Background and study aims
Depression is one of the most common mental disorders worldwide. The symptoms of depression can vary greatly from person to person, but generally include low mood, problems with sleeping and/or eating, and a general loss of interest in life. Treatment for depression often relies heavily on antidepressant medications. It is thought that antidepressants work by increasing the levels of certain chemicals in the brain called neurotransmitters. In 2013, there were over 53 million prescriptions for antidepressants in the UK, many of which were repeat prescriptions. This is because they are often taken continuously by patients, to prevent future episodes of depression (maintenance treatment). The current NICE guidelines recommend people “at risk of relapse” should remain on maintenance antidepressants for two years, although there is currently little evidence to support this policy. UK surveys have shown that between 5% and 8% of the general public are taking antidepressants, and up to half of these have been taking them long-term. Many of these people no longer show symptoms of depression, and so the benefits of continuing treatment are debatable. The aim of this study is to evaluate the effectiveness of long-term maintenance treatment for depression in the UK.
Who can participate?
Adults with depression who have been taking antidepressants for at least 9 months, and are willing to consider stopping their medication.
What does the study involve?
Participants are randomly allocated into one of two groups. Those in the first group continue to take their medication (citalopram 20mg, sertraline 100mg, fluoxetine 20mg or mirtazapine 30mg) for the entire study period. Those in the second group take half the dose of their current medication for four weeks, and then take a dummy pill (placebo) for the remainder of the study. At the start of the study and then at 12, 26, 39 and 52 weeks, all participants complete a number of questionnaires to find out if there have been any changes in their mood.
What are the possible benefits and risks of participating?
Not provided at time of registration
Where is the study run from?
University College London (UK)
When is the study starting and how long is it expected to run for?
August 2015 to July 2019
Who is funding the study?
National Institute for Health Research (UK)
Who is the main contact?
Mrs Larisa Duffy
Mrs Larisa Duffy
UCL Division of Psychiatry
149 Tottenham Court Road
+44 (0)20 7679 9282
HTA 13/115/48; 14/0647
A Phase IV double blind multi-site, individually randomised parallel group controlled trial investigating the use of citalopram, sertraline, fluoxetine and mirtazapine in preventing relapse in patients in primary care who are taking long term maintenance antidepressants but now feel well enough to consider stopping medication
Maintenance antidepressants reduce the rate of relapse in people who have recovered from depression and have been taking maintenance antidepressants for 9 months.
More details can be found at: http://www.nets.nihr.ac.uk/projects/hta/1311548
East of England - Cambridge South Research Ethics Committee, 29/03/2016, REC ref: 16/EE/0032
Phase IV double-blind multi-site randomised parallel-group controlled trial
Primary study design
Secondary study design
Randomised controlled trial
Patient information sheet
Not available in web format, please use the contact details below to request a patient information sheet
At baseline participants will be taking either citalopram (20mg), sertraline (100mg), fluoxetine (20mg) or mirtazapine (30mg). They will be randomised into one of two groups:
Control Group: Those in the control group remain on their current medication throughout the study period.
Intervention Group: Those in the intervention group take half the dose of their current medication for a period of four weeks (citalopram 10mg, sertraline, 50mg, fluoxetine 10mg or mirtazapine 15mg), and take a placebo for the remainder of the study period. All medications are given in Pill form.
Primary outcome measures
Time to depressive relapse measured using the modified shortened clinical interview schedule-revised (CIS-R) at baseline, 12 weeks, 26 weeks, 39 weeks and 52 weeks.
Secondary outcome measures
1. Depressive symptoms will be measured using the PHQ9 at baseline, 12 weeks, 26 weeks, 39 weeks, 52 weeks
2. Anxiety symptoms will be measured using the GAD7 questionnaire at baseline, 12 weeks, 26 weeks, 39 weeks, 52 weeks
3. Quality of life will be measured using the EQ5D-5L questionnaire for quality adjusted life years (QALYs) at baseline, 12 weeks, 26 weeks, 39 weeks, 52 weeks
4. Adverse effects of antidepressants will be measured using a modified Toronto Side Effects scale at baseline, 12 weeks, 26 weeks, 39 weeks, 52 weeks
5. Adherence to study medication will be measured using the modified Morisky scale at baseline, 12 weeks, 26 weeks, 39 weeks, 52 weeks
6. Quality of life will be measured using the Health related quality of life questionnaire (SF12) at baseline, 12 weeks, 26 weeks, 39 weeks, 52 weeks
Overall trial start date
Overall trial end date
Participant inclusion criteria
1. Aged between 18 and 74 years
2. Have experienced at least two episodes of depression
3. Have been taking antidepressants for at least 9 months (citalopram 20mg, sertraline 100mg, fluoxetine 20mg or mirtazapine 30mg)
4. Be well enough to consider stopping their antidepressant medication
Target number of participants
Participant exclusion criteria
1. Meet internationally agreed (ICD10) criteria for a depressive illness
2. Score above 10 on the depressive symptom questionnaire (PHQ9)
3. Have bipolar disorder, psychotic illness, dementia or a terminal illness
4. Are not able to complete self-administered questionnaires in English
5. Have contraindications for any of the prescribed medication
Recruitment start date
Recruitment end date
Countries of recruitment
Trial participating centre
University College London
149 Maple House Tottenham Court Road
UCL Medical School
Upper 3rd Floor
Royal Free Campus
Rowland Hill Street
+44 (0)20 7794 0500 ext 36724
Health Technology Assessment Programme
NIHR Health Technology Assessment Programme, HTA
Funding Body Type
Funding Body Subtype
Results and Publications
Publication and dissemination plan
Not provided at time of registration.
Intention to publish date
Participant level data
To be made available at a later date
Results - basic reporting