Managing Antidepressant Discontinuation: A Systematic Review

Ann Fam Med. 2019 Jan; 17(1): 52–60

Stopping antidepressants is frequently associated with withdrawal symptoms, which can be problematic, and mistaken for relapse/recurrence. It’s normally advised to taper the dose over weeks. Current guidelines for antidepressant discontinuation are based on consensus, and nonsystematic reviews have identified a need for more controlled data.

This systematic review answers 1) what interventions are effective in managing antidepressant discontinuation 2) what are the outcomes for patients after discontinuation.

This study supports consensus guidance that antidepressants should be tapered over 1-2 weeks rather than discontinued abruptly. Discontinuation symptoms are probably reduced by tapering, but slow tapering is a challenge given a lack of suitable formulations

Discontinuation took place in some studies during “continuation” treatment to prevent relapse within 4 to 6 months of remission, and in others during “maintenance” treatment to prevent a recurrence. This distinction is potentially important because guidelines recommend 6 to 9 months of continuation treatment for the first episode of depression and maintenance treatment for 2 years or longer for recurrent episodes. The clinical utility of this distinction has however been questioned by a systematic review that found no clear difference between continuation and maintenance treatment in reducing the risk of relapse/recurrence.

Alternately, having an effective therapy for the depression or anxiety for which the medication was initially given removes the need for it, without increasing relapse/recurrence risk. Access to face-to-face CBT or MBCT is likely to be quite limited, however. This situation warrants exploration of psychologically informed digital support for discontinuation to complement primary care clinician management, given the high prevalence of people on potentially inappropriate long-term antidepressant treatment. LINK

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