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Review ArticleSystematic Review

Managing Antidepressant Discontinuation: A Systematic Review

Emma Maund, Beth Stuart, Michael Moore, Christopher Dowrick, Adam W.A. Geraghty, Sarah Dawson and Tony Kendrick
The Annals of Family Medicine January 2019, 17 (1) 52-60; DOI: https://doi.org/10.1370/afm.2336
Emma Maund
1Primary Care & Population Sciences, University of Southampton, Aldermoor Health Centre, Southampton, United Kingdom
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Beth Stuart
1Primary Care & Population Sciences, University of Southampton, Aldermoor Health Centre, Southampton, United Kingdom
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Michael Moore
1Primary Care & Population Sciences, University of Southampton, Aldermoor Health Centre, Southampton, United Kingdom
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Christopher Dowrick
2Institute of Psychology Health and Society, University of Liverpool, Liverpool, United Kingdom
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Adam W.A. Geraghty
1Primary Care & Population Sciences, University of Southampton, Aldermoor Health Centre, Southampton, United Kingdom
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Sarah Dawson
3Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
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Tony Kendrick
1Primary Care & Population Sciences, University of Southampton, Aldermoor Health Centre, Southampton, United Kingdom
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  • For correspondence: A.R.Kendrick@soton.ac.uk
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Abstract

PURPOSE We aimed to determine the effectiveness of interventions to manage antidepressant discontinuation, and the outcomes for patients.

METHODS We conducted a systematic review with narrative synthesis and meta-analysis of studies published to March 2017. Studies were eligible for inclusion if they were randomized controlled trials, quasi-experimental studies, or observational studies assessing interventions to facilitate discontinuation of antidepressants for depression in adults. Our primary outcomes were antidepressant discontinuation and discontinuation symptoms. Secondary outcomes were relapse/recurrence; quality of life; antidepressant reduction; and sexual, social, and occupational function.

RESULTS Of 15 included studies, 12 studies (8 randomized controlled trials, 2 single-arm trials, 2 retrospective cohort studies) were included in the synthesis. None were rated as having high risk for selection or detection bias. Two studies prompting primary care clinician discontinuation with antidepressant tapering guidance found 6% and 7% of patients discontinued, vs 8% for usual care. Six studies of psychological or psychiatric treatment plus tapering reported cessation rates of 40% to 95%. Two studies reported a higher risk of discontinuation symptoms with abrupt termination. At 2 years, risk of relapse/recurrence was lower with cognitive behavioral therapy plus taper vs clinical management plus taper (15% to 25% vs 35% to 80%: risk ratio = 0.34; 95% CI, 0.18–0.67; 2 studies). Relapse/recurrence rates were similar for mindfulness-based cognitive therapy with tapering and maintenance antidepressants (44% to 48% vs 47% to 60%; 2 studies).

CONCLUSIONS Cognitive behavioral therapy or mindfulness-based cognitive therapy can help patients discontinue antidepressants without increasing the risk of relapse/recurrence, but are resource intensive. More scalable interventions incorporating psychological support are needed.

Key words
  • mental health
  • depression
  • antidepressants
  • discontinuation syndrome
  • primary care
  • prescribing
  • deprescribing
  • Received for publication June 14, 2018.
  • Revision received October 8, 2018.
  • Accepted for publication November 1, 2018.
  • © 2019 Annals of Family Medicine, Inc.
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The Annals of Family Medicine: 17 (1)
The Annals of Family Medicine: 17 (1)
Vol. 17, Issue 1
January/February 2019
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Managing Antidepressant Discontinuation: A Systematic Review
Emma Maund, Beth Stuart, Michael Moore, Christopher Dowrick, Adam W.A. Geraghty, Sarah Dawson, Tony Kendrick
The Annals of Family Medicine Jan 2019, 17 (1) 52-60; DOI: 10.1370/afm.2336

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Managing Antidepressant Discontinuation: A Systematic Review
Emma Maund, Beth Stuart, Michael Moore, Christopher Dowrick, Adam W.A. Geraghty, Sarah Dawson, Tony Kendrick
The Annals of Family Medicine Jan 2019, 17 (1) 52-60; DOI: 10.1370/afm.2336
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Subjects

  • Domains of illness & health:
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Keywords

  • mental health
  • depression
  • antidepressants
  • discontinuation syndrome
  • primary care
  • prescribing
  • deprescribing

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