Slow taper and psychotherapy may be best strategy for coming off antidepressants

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 could prevent one in every five patients relapsing into depression, the analysis found.

The conclusion comes after a 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.

It 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, they added and the quality of evidence around the psychological support was low.

But overall, the analysis found moderate-quality evidence that after successful treatment of depression, slow tapering of antidepressants combined with psychological support prevented relapse over the following year to a similar extent as remaining on an antidepressant at standard doses.

Continuing with reduced antidepressant doses was better than 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.

Study lead Professor Giovanni Ostuzzi from 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.’

Professor Hamish McAllister-Williams, professor of affective disorders at Newcastle University and 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. 

‘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.

‘There still remains a risk they could still relapse.’