Gradual Reduction With Therapy Offers Best Path To Discontinuing Antidepressants, Research Indicates

Adults who have recovered from depression may be able to stop taking antidepressants safely by gradually reducing their dosage while receiving structured psychological support, according to the latest research published in The Lancet Psychiatry.

The comprehensive review provides fresh evidence to inform clinical decisions around ending antidepressant treatment.

Current medical guidelines generally recommend continuing antidepressants for six to nine months after a first episode of moderate‑to‑severe depression to help prevent relapse.

However, concerns about long‑term use, overprescribing and withdrawal symptoms have prompted scientists to investigate the best ways to discontinue these medications.

Researchers from the University of Verona in Italy analysed data from 76 randomised controlled trials involving 17,379 adults who had achieved remission from depression or anxiety while on antidepressants.

The review directly compared various deprescribing strategies, including abrupt cessation, fast tapering (four weeks or less), slow tapering (more than four weeks), dose reduction and continuation of medication, each with or without psychological support.

The results indicated that slow tapering of antidepressants combined with psychological support reduced the risk of relapse over the subsequent year to a similar extent as remaining on the antidepressant at full dose.

The researchers estimated that slow tapering with psychological support could stop relapse in one out of every five people, compared with sudden stopping or rapid tapering, which carried higher relapse risks.

Importance of Personalised Deprescribing

Lead author Professor Giovanni Ostuzzi highlighted that the findings do not suggest antidepressants are unnecessary, nor that therapy alone is a sufficient replacement.

Instead, the research underscores the need for individualised deprescribing plans that combine gradual dose reduction with tailored psychological assistance.

Experts caution that while psychological support enhances outcomes, the evidence for its standalone effectiveness is less robust and requires further confirmation.

Additionally, the review found that continuing antidepressants at reduced doses may be more beneficial than abrupt stopping or fast tapering, though this evidence was weaker.

Importantly, the analysis found no significant differences in the occurrence of side effects or treatment dropouts across the various deprescribing strategies, suggesting that slow tapering with support is both effective and well‑tolerated.

However, information on withdrawal symptoms and other quality‑of‑life measures was limited in the available studies.

Researchers say the study provides much‑needed clarity on antidepressant discontinuation, a topic that has traditionally lacked robust evidence.

They emphasise the importance of discussing any plans to stop medication with a healthcare professional to determine the most appropriate strategy for each individual.

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