Stopping antidepressants safely

Abstract

Long-term antidepressant pharmacotherapy is frequently continued beyond guideline-recommended durations. This occurs particularly among women, despite limited evidence of ongoing benefit for many people treated for mild-to-moderate depression and an increasing burden of adverse effects over time. In randomised trials, average symptom improvement over placebo is small (approximately 2 points on the 52-point Hamilton Depression Rating Scale), with an estimated number needed to treat of about 7–10 for a clinically meaningful benefit, underscoring the importance of planning for discontinuation once treatment is initiated. Antidepressant withdrawal is common yet under-recognised: at least half of people experience withdrawal symptoms when stopping, with risk and severity increasing with higher doses, longer duration of use and prior withdrawal experiences. This Therapeutic Letter outlines a practical, patient-centred approach to deprescribing that tailors tapering to individual risk, uses clinical response to guide the pace of reduction and emphasises careful differentiation of withdrawal symptoms from relapse. To minimise harms, abrupt discontinuation should be avoided; higher-risk patients may require very gradual tapering over months or years, often using hyperbolic dose reductions enabled by liquid formulations or dissolving tablets, with close follow-up every 2–4 weeks and the option to pause or reverse tapering if symptoms emerge. The guidance also highlights strategies for challenging presentations, including withdrawal-associated akathisia and protracted withdrawal, alongside patient education, shared decision-making and informed consent to support safer discontinuation and improved outcomes.