Prescriptions for antidepressant treatment proceed to rise within the UK and globally, partly pushed by growing long-term therapy (Mars et al., 2017). Current information counsel that, in England, round 1 in 15 folks 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 out to be “remitted” (Eveleigh et al., 2019). At this level, some could really feel prepared to scale back their dose or cease therapy altogether however could also be uncertain of the most secure option 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 greater for sufferers who have been discontinuing therapy in contrast with sufferers sustaining their traditional dose (as summarised in Raphael and Sameer’s Psychological Elf weblog), highlighting potential issues with discontinuation.
Medical tips provide broad sensible recommendation on tips on how to handle antidepressant discontinuation. Tapering plans (the place the affected person regularly reduces their dose over time) are normally created on a case-by-case foundation between the affected person and their GP, however the optimum velocity and construction of tapering stays unsure (van Leeuwen et al., 2024). Sufferers and clinicians alike would profit from realizing which deprescribing methods minimise relapse danger and the chance of withdrawal results, which is precisely what this systematic evaluation and community evaluation by Zaccoletti and colleagues (2025) aimed to do.
People which have recovered following antidepressant therapy usually want to cut back or cease their therapy, however are uncertain about one of the simplest ways 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 anxiousness issues, who have been absolutely 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
- Gradual 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 information utilizing a standardised kind. 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 anxiousness have been analysed collectively after separate analyses confirmed the outcomes have been broadly related. Additionally they in contrast the outcomes of various methods throughout completely different lessons of antidepressants and confirmed that these results have been additionally constant.
The crew additionally assessed danger of bias, heterogeneity, inconsistency, and performed a number of sensitivity analyses. Danger of bias was assessed utilizing the Cochrane Danger-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 absolutely 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 probably the most often used antidepressants. Solely 5% acquired 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 customary dose with psychological help (relative danger [RR] = 0.40, 95% confidence interval [CI] [0.26 to 0.61]), adopted by persevering with at customary dose with out help (RR = 0.51, 95% CI [0.46 to 0.58]), and at last sluggish 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 sluggish tapering alone didn’t differ considerably from abrupt discontinuation.
Therapy rankings positioned continuation plus psychological help because the top-performing strategy, carefully adopted by sluggish tapering plus psychological help. The outcomes seemed to be constant throughout the completely 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 issues, the proof for SNRIs, tricyclics, and anxiousness issues was much less sure because of the restricted information out there for these drug lessons. Another classification of “very sluggish tapering” (>12 weeks) was additionally thought-about 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 widespread in these persevering with antidepressants than people discontinuing therapy.
Past antidepressant continuation, the simplest technique for stopping danger of relapse in melancholy is sluggish tapering together with psychological help.
Conclusions
This community meta-analysis reveals that sluggish 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 similar to persevering with treatment, whereas abrupt stopping and quick tapering considerably enhance relapse danger and ought to be prevented. Psychological help enhances the effectiveness of tapering, whereas help alone doesn’t enhance outcomes when persevering with or abruptly stopping. Though proof for anxiousness issues was restricted, total patterns counsel outcomes could generalise cautiously past melancholy.
This evaluation 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 energy of the examine 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 examine designs and affected person teams additionally makes the outcomes extra strong. Utilizing community meta-analysis allowed the analysis crew to match throughout a number of deprescribing methods too, even when trials didn’t straight examine them, enabling a clearer rating of the completely different scientific approaches, which may inform scientific decision-making. The authors additionally utilized rigorous methodology, together with duplicate screening and information 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 understanding 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 establish the deprescribing circumstances beneath which psychological help is almost definitely to scale back relapse danger. Such insights can information clinicians in deciding when and tips on how to prescribe further remedy throughout discontinuation. Lastly, additionally 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 examine’s key findings is necessary, to put the ends in context and ideally contribute to the significant implementation of findings. It’s a disgrace that this suggestions was not reported, however this may increasingly have been past the scope of the examine’s report.
Nevertheless, some limitations should even be thought-about:
- The classification of tapering methods (quick vs sluggish taper) was considerably arbitrary and never grounded inside earlier literature or pre-existing scientific definitions. Though this distinction could have obscured significant variations in tapering, the authors did check an alternate definition of sluggish tapering (‘very sluggish tapering’, >12 weeks) in a sensitivity evaluation and located related outcomes.
- The research of sufferers struggling anxiousness issues have been underrepresented (~ 20%) and subsequently solely included proof for fewer methods, limiting generalisability to those issues.
- Proof on the extra help provided by psychological remedy was additionally comparatively sparse, that means that any conclusions in regards to the effectiveness of prescribing psychotherapy alongside a sluggish taper, though promising, ought to be thought-about preliminary.
Findings point out that psychological help lowers danger of relapse throughout sluggish tapering. Nevertheless, restricted proof means it isn’t potential to attract agency conclusions on their mixed effectiveness.
Implications for observe
These outcomes present invaluable perception for sufferers occupied with stopping antidepressants, in addition to clinicians deciding on the very best technique to handle antidepressant withdrawal. The primary 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 finest to deprescribe, it appears to be most secure to comply with a sluggish tapering plan with further help, which aligns with steering from the Nationwide Institute for Well being and Care Excellence (NICE, 2022) to:
slowly cut back the dose to zero in a stepwise style, at every step prescribing a proportion of the earlier dose (for instance, 50% of earlier dose).
The findings of this evaluation reinforce the significance of clinicians working with sufferers to create a personalised tapering plan that enables them to regularly cut back their antidepressant dose over time. The outcomes additionally counsel that present scientific tips might go additional by recommending a minimal tapering interval of a minimum of one month, notably 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 sluggish 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 simpler at treating extreme melancholy than treatment alone (Cuijpers et al., 2023), so psychological remedy throughout withdrawal could provide equally significant advantages.
Future analysis ought to deal with making detailed comparisons of the effectiveness of various strategies of deprescribing, as a substitute of evaluating upkeep with a single technique of antidepressant discontinuation. Importantly, information on withdrawal signs have been scarce and infrequently poorly measured within the reviewed research, limiting the power to evaluate their position in relapse and the affect of every deprescribing technique on withdrawal-related results (learn Hannah’s Psychological Elf weblog to study extra about folks’s lived experiences of withdrawal signs). This evaluation 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 evaluation align with present NICE tips concerning the deprescription of antidepressants, but additionally emphasise the significance of clinicians working with sufferers to create tailor-made tapering plans that work finest for them.
Statements of curiosity
None to declare.
Edited by
Dr Nina Higson-Sweeney.
Hyperlinks
Main 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 evaluation and community meta-analysis. The Lancet Psychiatry, Quantity 13, Problem 1, 24 – 36
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