Prescriptions for antidepressant treatment proceed to rise within the UK and globally, partly pushed by rising long-term therapy (Mars et al., 2017). Latest knowledge counsel that, in England, round 1 in 15 individuals at the moment are receiving a prescription for antidepressant treatment (NHSBSA, 2025).
Some people report significant alleviation of their signs from these drugs and enter restoration or turn into “remitted” (Eveleigh et al., 2019). At this level, some could really feel prepared to cut back their dose or cease therapy altogether however could also be uncertain of the most secure approach to go about discontinuing their antidepressants, usually worrying about relapse or withdrawal signs in the event that they try to take action (Eveleigh et al., 2019; Meißner et al., 2024). A double-blind randomised managed trial (ANTLER) performed by Lewis et al. (2021) discovered relapse danger was larger for sufferers who have been discontinuing therapy in contrast with sufferers sustaining their standard dose (as summarised in Raphael and Sameer’s Psychological Elf weblog), highlighting potential issues with discontinuation.
Scientific tips supply broad sensible recommendation on the right way to handle antidepressant discontinuation. Tapering plans (the place the affected person regularly reduces their dose over time) are often created on a case-by-case foundation between the affected person and their GP, however the optimum pace and construction of tapering stays unsure (van Leeuwen et al., 2024). Sufferers and clinicians alike would profit from understanding which deprescribing methods minimise relapse danger and the probability of withdrawal results, which is precisely what this systematic overview and community evaluation by Zaccoletti and colleagues (2025) aimed to do.
People which have recovered following antidepressant therapy usually want to scale back or cease their therapy, however are uncertain about the easiest way to do that.
Strategies
Researchers searched medical databases and trial registries as much as April 2025 for randomised managed trials (RCTs) involving adults with depressive or nervousness problems, who have been totally or partially remitted at randomisation and taking an antidepressant. They categorised the discontinuation methods as:
- Abrupt discontinuation
- Quick tapering (gradual antidepressant discontinuation over ≤ 4 weeks) with or with out psychological help
- Sluggish tapering (>4 weeks) with or with out psychological help
Additionally they included continuation therapy with or with out psychological help. Two researchers independently screened titles, abstracts, and full texts and extracted knowledge utilizing a standardised type. Outcomes have been analysed utilizing random-effects community meta-analysis, with relapse fee on the finish of the trial as the first endpoint. People with melancholy and nervousness have been analysed collectively after separate analyses confirmed the outcomes have been broadly related. Additionally they in contrast the outcomes of various methods throughout totally different courses of antidepressants and confirmed that these results have been additionally constant.
The group additionally assessed danger of bias, heterogeneity, inconsistency, and performed a number of sensitivity analyses. Threat of bias was assessed utilizing the Cochrane Threat-of-Bias instrument 2 and deemed to be low in 53% of research, excessive in 28%, and raised some issues in 20%.
Outcomes
Examine traits
Seventy-six RCTs involving 17,379 contributors have been included (imply age = 45.9 years; imply proportion feminine = 67.5%). Throughout research, there was a mean follow-up of 46 weeks, with most trials involving people with main depressive dysfunction (79%).
Of the whole pattern, 81.7% have been totally remitted and 18.3% partially remitted on the baseline. A lot of the contributors have been persevering with antidepressant therapy at the usual dose (51%) adopted by abrupt stopping (20%), and quick tapering (19%). Selective Serotonin Reuptake Inhibitors (SSRIs; 40%) and Serotonin Noradrenergic Reuptake Inhibitors (SNRIs; 23%) have been essentially the most incessantly used antidepressants. Solely 5% obtained psychological help within the type of mindfulness-based cognitive remedy, preventive cognitive remedy, or cognitive behavioural remedy (CBT).
Community meta-analysis
Utilizing abrupt stopping because the reference deprescribing technique, the simplest technique for stopping the chance of relapse was persevering with the antidepressant at commonplace dose with psychological help (relative danger [RR] = 0.40, 95% confidence interval [CI] [0.26 to 0.61]), adopted by persevering with at commonplace dose with out help (RR = 0.51, 95% CI [0.46 to 0.58]), and at last gradual tapering with psychological help (RR = 0.52, 95% CI [0.38 to 0.72]). Persevering with at a decreased dose additionally confirmed profit however with decrease certainty (RR = 0.62, 95% CI [0.42 to 0.92]). In distinction, quick tapering with psychological help, abrupt stopping with psychological help, and gradual tapering alone didn’t differ considerably from abrupt discontinuation.
Therapy rankings positioned continuation plus psychological help because the top-performing strategy, intently adopted by gradual tapering plus psychological help. The outcomes gave the impression to be constant throughout the totally different sensitivity analyses. The RR estimates of every technique have been much less exact after excluding high-risk or industry-sponsored research, however the order of most to least efficient methods remained the identical.
While constant results have been present in subgroup analyses for SSRIs and for depressive problems, the proof for SNRIs, tricyclics, and nervousness problems was much less sure because of the restricted knowledge accessible for these drug courses. An alternate classification of “very gradual tapering” (>12 weeks) was additionally thought of and located this technique was solely efficient when the tapering was mixed with psychological help. No significant variations emerged between discontinuation methods on opposed occasions, severe opposed occasions, or charges of finishing discontinuation. Surprisingly, withdrawal-related results have been barely extra frequent in these persevering with antidepressants than people discontinuing therapy.
Past antidepressant continuation, the simplest technique for stopping danger of relapse in melancholy is gradual tapering together with psychological help.
Conclusions
This community meta-analysis exhibits that gradual tapering mixed with psychological help is an efficient and well-tolerated technique for discontinuing antidepressants in remitted people. Its safety in opposition to relapse is corresponding to persevering with treatment, whereas abrupt stopping and quick tapering considerably improve relapse danger and needs to be averted. Psychological help enhances the effectiveness of tapering, whereas help alone doesn’t enhance outcomes when persevering with or abruptly stopping. Though proof for nervousness problems was restricted, general patterns counsel outcomes could generalise cautiously past melancholy.
This overview underscores the significance of regularly decreasing antidepressant treatment and strongly discourages stopping abruptly or rapidly (in 4 weeks or much less).
Strengths and limitations
A serious power of the research was its complete proof base, synthesising 76 RCTs and greater than 17,000 contributors; considerably bigger than many earlier meta-analyses on antidepressant discontinuation. This implies the findings relaxation on a massive, well-powered dataset that strengthens the statistical reliability of the conclusions, whereas the inclusion of numerous research designs and affected person teams additionally makes the outcomes extra strong. Utilizing community meta-analysis allowed the analysis group to check throughout a number of deprescribing methods too, even when trials didn’t straight examine them, enabling a clearer rating of the totally different medical approaches, which may inform medical decision-making. The authors additionally utilized rigorous methodology, together with duplicate screening and knowledge extraction, formal risk-of-bias evaluation, analysis of transitivity and inconsistency, and in depth sensitivity, subgroup, and meta-regression analyses, which collectively strengthen the reliability of the findings.
Additional, presenting certainty rankings alongside impact sizes permits for a extra dependable interpretation of the effectiveness of every technique that takes under consideration the knowledge of every impact, persevering with to strengthen our belief within the findings. Importantly, incorporating trials with psychological help enabled the first strong, head-to-head comparability of tapering methods with and with out psychotherapy. This issues as a result of it helps determine the deprescribing circumstances beneath which psychological help is most probably to cut back relapse danger. Such insights can information clinicians in deciding when and the right way to prescribe extra remedy throughout discontinuation. Lastly, in addition they consulted a bunch of people with related lived experiences that knowledgeable the interpretation and dissemination of their analyses. Participating with members of the general public on the research’s key findings is necessary, to position the leads to context and ideally contribute to the significant implementation of findings. It’s a disgrace that this suggestions was not reported, however this may occasionally have been past the scope of the research’s report.
Nonetheless, some limitations should even be thought of:
- The classification of tapering methods (quick vs gradual taper) was considerably arbitrary and never grounded inside earlier literature or pre-existing medical definitions. Though this distinction could have obscured significant variations in tapering, the authors did take a look at another definition of gradual tapering (‘very gradual tapering’, >12 weeks) in a sensitivity evaluation and located related outcomes.
- The research of sufferers struggling nervousness problems have been underrepresented (~ 20%) and subsequently solely included proof for fewer methods, limiting generalisability to those problems.
- Proof on the extra help provided by psychological remedy was additionally comparatively sparse, which means that any conclusions in regards to the effectiveness of prescribing psychotherapy alongside a gradual taper, though promising, needs to be thought of preliminary.
Findings point out that psychological help lowers danger of relapse throughout gradual tapering. Nonetheless, restricted proof means it isn’t doable to attract agency conclusions on their mixed effectiveness.
Implications for apply
These outcomes present beneficial perception for sufferers fascinated with stopping antidepressants, in addition to clinicians deciding on one of the best methodology to handle antidepressant withdrawal. The principle message is obvious: keep away from abrupt discontinuation or tapering too rapidly, as each approaches increase the probabilities of melancholy returning. As a substitute, when contemplating how greatest to deprescribe, it appears to be most secure to comply with a gradual tapering plan with extra help, which aligns with steering from the Nationwide Institute for Well being and Care Excellence (NICE, 2022) to:
slowly scale back the dose to zero in a stepwise vogue, at every step prescribing a proportion of the earlier dose (for instance, 50% of earlier dose).
The findings of this overview reinforce the significance of clinicians working with sufferers to create a personalised tapering plan that enables them to regularly scale back their antidepressant dose over time. The outcomes additionally counsel that present medical tips may go additional by recommending a minimal tapering interval of not less than one month, significantly the place the affected person is anxious about relapse or has skilled problem stopping therapy beforehand. The potential added advantages of psychological help when mixed with a gradual tapering regime can be highlighted, though a lot additional analysis is required disentangle its particular contribution to decreasing relapse danger. Earlier analysis has proven that psychological remedy alongside antidepressant treatment appears to be more practical at treating extreme melancholy than treatment alone (Cuijpers et al., 2023), so psychological remedy throughout withdrawal could supply equally significant advantages.
Future analysis ought to concentrate on making detailed comparisons of the effectiveness of various strategies of deprescribing, as an alternative of evaluating upkeep with a single methodology of antidepressant discontinuation. Importantly, knowledge on withdrawal signs have been scarce and sometimes poorly measured within the reviewed research, limiting the flexibility to evaluate their function in relapse and the influence of every deprescribing technique on withdrawal-related results (learn Hannah’s Psychological Elf weblog to be taught extra about individuals’s lived experiences of withdrawal signs). This overview highlights the ongoing gaps in information on withdrawal signs and the necessity for extra longitudinal assessments of discontinuation results while sufferers are regularly decreasing their treatment.
The findings of this overview align with present NICE tips relating to the deprescription of antidepressants, but in addition emphasise the significance of clinicians working with sufferers to create tailor-made tapering plans that work greatest for them.
Statements of curiosity
None to declare.
Edited by
Dr Nina Higson-Sweeney.
Hyperlinks
Major paper
Zaccoletti, D., Mosconi, C., Gastaldon, C., Benedetti, L., Gottardi, C., Papola, D., Ponzi, O., Purgato, M., Naudet, F., Cristea, I. A., Barbui, C., & Ostuzzi, G. (2025). Comparability of antidepressant deprescribing methods in people with clinically remitted melancholy: a scientific overview and community meta-analysis. The Lancet Psychiatry, Quantity 13, Subject 1, 24 – 36
Different references
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Eveleigh, R., Speckens, A., van Weel, C., Oude Voshaar, R., & Lucassen, P. (2019). Sufferers’ attitudes to discontinuing not-indicated long-term antidepressant use: Obstacles and facilitators. Therapeutic Advances in Psychopharmacology, 9, 2045125319872344. https://doi.org/10.1177/2045125319872344
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