## Gradual Antidepressant Discontinuation wiht Therapy May Be as Effective as Continued Medication

Gradually discontinuing antidepressants with the support of psychological therapy may be as effective as remaining on medication for preventing depression relapse, according to the largest and most comprehensive review to date on how best to stop antidepressants.¹ The findings, published in *The lancet Psychiatry*, offer some of the clearest evidence yet to guide deprescribing practices amid growing concerns about long-term use and withdrawal symptoms.

“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,” lead author Giovanni Ostuzzi, PhD, of the University of Verona in Italy, said in a statement.² “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. Many people do not wish to stay on medication indefinitely, and some experience troublesome side effects. Still, there has been little rigorous research into the safest and most effective approaches to discontinue treatments.”

The systematic review and network meta-analysis analyzed 76 randomized controlled trials involving 17,379 adults who had achieved full or partial remission from depression or anxiety while taking antidepressants, most commonly selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs).¹ The majority of participants were White (88%) and had a mean age of 45 years; most were women.

[Image credit: sitthiphong – stock.adobe.com]

Slow tapering combined with therapy was an effective strategy for preventing relapse in depression.
Image Credit: sitthiphong – stock.adobe.com

Depression Treatment: A Focus on Safe Medication Reduction

Individuals successfully managing their depression often want to explore reducing or stopping antidepressant medication. However, doing so safely requires careful planning and support. Recent research emphasizes the need for updated clinical guidelines and more accessible psychological interventions to facilitate this process.

A systematic review and network meta-analysis, published in The Lancet, highlights the challenges of antidepressant deprescribing. Dr. Zaccoletti, PsyD, from the University of Verona, points out that “considerable healthcare resources are needed to develop and implement dedicated psychotherapy approaches in clinical practice.” She advocates for testing and prioritizing cost-effective, short-term, scalable, and remotely delivered interventions.

The findings underscore the importance of regular treatment reviews and individualized deprescribing plans.This means gradually tapering medication dosages while simultaneously providing structured psychological support. Patients feeling better and wanting to discontinue medication shouldn’t do so abruptly. A carefully managed approach minimizes the risk of relapse.

Dr. Zaccoletti further emphasizes that current clinical guidelines should be updated to reflect these best practices. Supporting patients through this transition requires a collaborative effort between healthcare providers and individuals seeking to manage their mental health long-term.

References

1. zaccoletti D, Mosconi C, Gastaldon C, et al. Comparison of antidepressant deprescribing strategies in individuals with clinically remitted depression: a systematic review and network meta-analysis. The Lancet.