Academics have identified the most effective method for discontinuing antidepressant medication, suggesting a gradual reduction in dosage combined with psychological support.
This approach, known as tapering, has been found to significantly lower the risk of depression relapse.
Researchers indicate that this slow, supported withdrawal could prevent relapse in one in five individuals, a marked improvement compared to abruptly stopping or rapid tapering.
The findings highlight the importance of a considered, supported process when coming off these medications.
Antidepressants can be recommended as a treatment for depression or anxiety.
The authors of the new paper, published in The Lancet Psychiatry, highlight how “concerns exist around overprescribing, long-term use”.
Experts said that for many patients, it is recommended that they discontinue treatment after around six to nine months.
Longer treatment can be given to patients with severe symptoms or repeated episodes of depression.
Nearly nine million patients in England took antidepressants last year, according to data from the NHS Business Services Authority.
Researchers, led by academics from the University of Verona in Italy, looked at “deprescribing strategies” among more than 17,300 patients who took part in 76 clinical trials.
Patients coming off antidepressants were an average age of 45 and were tracked for almost a year.
The risk of relapse for those stopping abruptly was nearly 40 per cent.
Fast tapering was almost as bad as abruptly stopping treatment, researchers said, adding that these mechanisms to stop treatment carried the highest risk of relapse.
The team found that continuing antidepressants coupled with psychological support reduced the risk of relapse by 60 per cent.
Continuing the antidepressant with no psychological support reduced the risk of relapse by 49 per cent.
But slow tapering plus psychological support was “as effective”– reducing risk of relapse by 48 per cent.
“We found that continuing with or without psychological support, slow tapering with the psychological support and continuing at the antidepressant at reduced doses had similar benefits in preventing relapse within the first year after stopping,” said lead author Professor Giovanni Ostuzzi from the University of Verona.
“We also found that abrupt stopping or fast tapering were similar and had the highest risk of relapse.”
Prof Corrado Barbui, also from the University of Verona, said: “The way they are stopped should follow a slow, rather than fast, approach and possibly with some kind of psychological support, to keep this as scalable as possible, this type of support should be short based on CBT (cognitive behavioural therapy).”
The strategies which “made no difference” in preventing a relapse for depression included slowly coming off the drugs without the additional support; fast tapering plus psychological support or abrupt stopping plus psychological support.
The research team said that guidelines on how to come off antidepressants should “promote individualised deprescribing with gradual tapering and structured psychological support”.
Prof Ostuzzi added: “Our new review clarifies the scientific evidence about the most effective way to come off antidepressants for individuals successfully treated for depression and could change how coming off antidepressants is managed globally.”
Co-author Dr Debora Zaccoletti, from the University of Verona, said: “These findings highlight the need for clinical guidelines to be updated to promote regular treatment reviews and individualised deprescribing with gradual tapering and structured psychological support for patients with depression who are feeling better and wish to come off their medication.”
The National Institute for Health and Care Excellence (Nice) created guidance in 2022 which included information on stopping antidepressants.
This guidance discusses the tapering of medication but says that some people may need more support to stop antidepressants successfully, which could include regular check-in phone calls, seeing them more frequently, advice on sleep hygiene from a clinician or therapist.
The NHS.uk website says that patients prescribed antidepressants will usually take them for at least six months after they feel better.
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