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Study compares antidepressant deprescribing strategies
It weighed up sudden stopping, fast and slow tapering, and dose reduction, ultimately backing a carefully tailored approach.
Although most guidelines recommend antidepressants be used for only 6–12 months for an episode of anxiety or depression, the average duration of use is four years.
Slowly tapering off antidepressants, combined with psychological support, could help prevent depression relapse in one in every five cases, according to international researchers.
The meta-analysis, published in Lancet Psychiatry, analysed 76 randomised controlled trials representing more than 17,000 adults.
It directly compared the effectiveness of all major strategies for deprescribing on the rate of relapse (a new episode of depression or anxiety), each with or without psychological support:
- Sudden stopping of an antidepressant – replaced by a placebo pill
- Fast tapering – reducing the medication dose over four weeks or less
- Slow tapering – reducing the medication dose over more than four weeks
- Dose reduction – 50% or less of the minimal effective dose
- Continuing antidepressant treatment
Results showed that for adults who have recovered from depression with the help of antidepressants, slow tapering antidepressants combined with psychological support is more effective than fast tapering off or suddenly stopping the medication.
This approach was estimated to prevent one relapse in every five individuals compared with abrupt stopping or fast tapering, offering a ‘clinically meaningful benefit’.
For anxiety, the authors note that the evidence was less robust and requires confirmation in dedicated trials to provide doctors and patients with accurate evidence-based information on which to base their decisions.
Antidepressants are recommended for moderate-to-severe depression and anxiety, but concerns exist around overprescribing, long-term use, and lack of evidence-based deprescribing strategies, the study stated.
The researchers recommend guidelines be updated to promote individualised deprescribing with gradual tapering and structured psychological support – a move the RACGP recently undertook.
In November, the
RACGP’s First Do No Harm resource was released to guide GPs on a best practice approach to deprescribing antidepressant medications (for example, serotonin reuptake inhibitors and serotonin and noradrenaline reuptake inhibitors), to minimise withdrawal syndrome and relapse.
It also provided information on conducting reviews, medication harms and risks, alternatives and additional resources, with a key message being that GPs do not continue to prescribe long-term medications for anxiety and depression without carefully reassessing their ongoing need and appropriateness.
In 2023–24, antidepressants were dispensed to 14% of the Australian population, with 92% of these scripts prescribed by GPs.
Although most guidelines recommend these medications be used for only 6–12 months for an episode of anxiety or depression, the average duration of use is four years, the RACGP guide explains.
Lead author of the
Lancet Psychiatry study, Professor Giovanni Ostuzzi from the University of Verona in Italy, said 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.’
Professor Ostuzzi said he hoped this new research provided a larger evidence base and more clarification for doctors on the most effective way to bring patients off antidepressants for successfully treated depression.
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