Managing Antidepressant Discontinuation: A Systematic Review

The Article in Brief

Managing Antidepressant Discontinuation: A Systematic Review

Tony Kendrick , and colleagues

Background Stopping antidepressants is frequently associated with withdrawal symptoms, which can be problematic and mistaken for relapse or recurrence. This study analyzes existing research to address two questions: what interventions are effective in managing antidepressant discontinuation, and what are the outcomes for patients following discontinuation?

What This Study Found When discontinuing antidepressants, the risk of relapse or recurrence is significantly reduced by combining cognitive behavior therapy with gradual tapering of the medication. At two years, risk of relapse or recurrence was lower with cognitive behavior therapy plus tapering (15-25 percent) compared to clinical management plus tapering (35-80 percent). Relapse/recurrence rates were similar for mindfulness-based cognitive therapy with tapering and maintenance antidepressants. In two studies prompting primary care clinician discontinuation with antidepressant tapering guidance, six percent and seven percent of patients discontinued, compared to eight percent for usual care. Six studies of psychological or psychiatric treatment plus tapering reported cessation rates of between 40 percent and 95 percent. Two studies reported a higher risk of discontinuation symptoms with abrupt termination of medication.

Implications

• The authors note that cognitive behavior therapy seems to improve discontinuation rates compared to primary care clinician management of tapering with brief guidance; however, patient access to such therapy may be limited. They call for exploration of psychologically informed digital support for discontinuing antidepressants to complement care provided by primary care clinicians.