A slow taper combined with psychological support appears to be the best strategy for stopping antidepressants, researchers have reported.
Compared with a fast taper or stopping taking antidepressants abruptly, a staged withdrawal of the drugs was found to prevent one in every five patients relapsing into depression.
This was the conclusion of a systematic review and network meta-analysis of studies involving more than 17,000 adults taking part in 76 randomised clinical trials.
Writing in The Lancet Psychiatry, the researchers said the findings do not suggest that antidepressants are unnecessary or that psychotherapy alone is adequate.
But the results underscore the importance of tailoring deprescribing to each individual, they added.
Slow tapering and psychological support superior
This is the largest analysis of deprescribing strategies to date and looked at a range of approaches.
No significant differences in reported side effects or number of dropouts were seen between the deprescribing strategies, and the quality of evidence around the psychological support was low, the researchers said.
But overall, the analysis found moderate-quality evidence that after successful treatment of depression, a slow tapering of antidepressants combined with psychological support prevented relapse over the following year to a similar extent as remaining on an antidepressant at a standard dose.
Continuing with reduced antidepressant doses was better than both abruptly stopping and fast tapering for reducing relapse, but with less strong evidence, the team reported.
The evidence on the best approach for patients with anxiety was less robust and should be studied further, they added.
Guidelines often overlooked for antidepressant deprescribing
Study lead Professor Giovanni Ostuzzi, assistant professor at the University of Verona in Italy, said: ‘Depression is often a recurring condition and without ongoing treatment as many as three out of four people with recurrent depression relapse at some point.
‘Clinical guidelines recommend continuing antidepressants for a certain period after remission, then considering discontinuation once the person has remained well. Yet in everyday practice, treatment is often prolonged far beyond what guidelines suggest.’
He added there had been little rigorous research into the safest and most effective approaches to discontinue treatments.
‘By incorporating a substantially larger evidence base, a broader range of deprescribing strategies, and direct head-to-head comparisons, our new review clarifies the scientific evidence about the most effective way to come off antidepressants for individuals successfully treated for depression and could change how coming off antidepressants is managed globally,’ he said.
Professor Hamish McAllister-Williams, professor of affective disorders at Newcastle University and consultant psychiatrist at Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, said the clearest finding from the analysis was that stopping antidepressants – through any discontinuation method and in the absence of psychotherapy – at least doubles the chances of becoming ill again over the next year.
‘The study also provides some support suggesting that if a person is going to stop an antidepressant that it is better to do this over at least four weeks, and that having psychotherapy at the time may also help,’ he said, adding that ‘this is useful information for patients and clinicians’.
But he stressed it was vitally important that patients do not think this study says there is no risk involved in stopping an antidepressant as long as they do it slowly as ‘there still remains a risk they could still relapse’.
Research published in the same journal in 2024 found that only one in six people who stop taking antidepressants will experience withdrawal symptoms as a direct result.
A version of this article was originally published by our sister publication Pulse.
