Gradual reduction of antidepressants together with psychological support can be an effective strategy to stop medication among adults who have recovered from depression, according to a study on Friday. Antidepressants are typically recommended to be taken for six to nine months after a first episode of moderate-to-severe depression and anxiety disorders to prevent relapse.
But there are concerns about overprescribing, long-term use, and withdrawal symptoms after discontinuation, which underscore the need for evidence-based deprescribing strategies. To understand, researchers from the University of Verona in Italy conducted a systematic review and network meta-analysis of 76 randomised controlled trials involving 17,379 adults.
The findings, published in The Lancet Psychiatry, do not suggest that antidepressants are unnecessary or that psychotherapy alone is adequate. Instead, it highlighted that the results underscore the importance of tailoring deprescribing to each individual, with a gradual individualised tapering of antidepressants alongside structured psychological support.
"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," said lead author Professor Giovanni Ostuzzi from the University of Verona in Italy.
"We encourage anyone considering coming off antidepressants to discuss the process with their doctor first to jointly find the best strategy for them," he added. The researchers estimated that slow tapering of antidepressants plus psychological support could prevent one relapse in every five individuals compared with abrupt stopping or fast tapering (the two least effective strategies) offering a clinically meaningful benefit.
Continuing with reduced antidepressant doses was also found to be better than abruptly stopping and fast tapering for reducing relapse, but the evidence for this was less strong. Notably, no significant differences in reported side effects or in the number of dropouts were observed between the deprescribing strategies.