Managing antidepressant discontinuation - the literature

Maund et al. have completed a systematic review regarding published studies that focused on reviewing, reducing and stopping antidepressants. 

Of the 15 studies outlined, 12 were included in the synthesis (eight randomized controlled trials, two single-arm trials, two retrospective cohort studies). 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 versus 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 two years, risk of relapse/recurrence was lower with cognitive behavioural therapy (CBT) plus taper versus clinical management plus taper (15% to 25% vs 35% to 80%: risk ratio = 0.34; 95% CI, 0.18-0.67; two studies).

Relapse/recurrence rates were similar for mindfulness-based cognitive therapy with tapering and maintenance antidepressants (44% to 48% vs 47% to 60%; two studies).

CBT or mindfulness-based cognitive therapy can help patients discontinue antidepressants without increasing the risk of relapse/recurrence but are resource intensive.